Provider Demographics
NPI:1043044654
Name:WILLIAMS, DWIGHT ERVING
Entity type:Individual
Prefix:
First Name:DWIGHT
Middle Name:ERVING
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 GRIMALDI WAY
Mailing Address - Street 2:
Mailing Address - City:HEDGESVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25427-6677
Mailing Address - Country:US
Mailing Address - Phone:304-703-9136
Mailing Address - Fax:
Practice Address - Street 1:818 GRIMALDI WAY
Practice Address - Street 2:
Practice Address - City:HEDGESVILLE
Practice Address - State:WV
Practice Address - Zip Code:25427-6677
Practice Address - Country:US
Practice Address - Phone:304-703-9136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant