Provider Demographics
NPI:1124909437
Name:WILLIAMS, BRIAN
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
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 1:1028 ELLIOTT RD
Mailing Address - Street 2:
Mailing Address - City:CROWN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:45623-9335
Mailing Address - Country:US
Mailing Address - Phone:740-612-2314
Mailing Address - Fax:
Practice Address - Street 1:1028 ELLIOTT RD
Practice Address - Street 2:
Practice Address - City:CROWN CITY
Practice Address - State:OH
Practice Address - Zip Code:45623-9335
Practice Address - Country:US
Practice Address - Phone:740-612-2314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty