Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 8188 | TN |
NPI | 1003132424 |
---|---|
Provider Name | Mr. James Roger Williams |
First Address | Gainesville, FL 32609-4219 |
Second Address | Gainesville, FL 32641-7346 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2010 |
Last Update Date | 09/04/2010 |