Individual
CHARLES WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1535 RIVER PARKWAY BLVD, #1108, SHREVEPORT, LA 71104-1808
(318) 828-1500
(318) 670-6736
Mailing address
1535 RIVER PARKWAY BLVD, #1108, SHREVEPORT, LA 71104-1808
(318) 828-1500
(318) 670-6736
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
2380885
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2380885
—
LA
Enumeration date
02/17/2016
Last updated
02/17/2016
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