Provider Demographics
NPI:1134772841
Name:WILLIAMS, DARRELL LEE SR (NA)
Entity type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:LEE
Last Name:WILLIAMS
Suffix:SR
Gender:M
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25814 BEECHAM RD # 2581
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-1511
Mailing Address - Country:US
Mailing Address - Phone:248-508-3563
Mailing Address - Fax:
Practice Address - Street 1:25814 BEECHAM
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-4833
Practice Address - Country:US
Practice Address - Phone:248-508-3563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIW452135497678343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)