Provider Demographics
NPI:1174402267
Name:WILLIAMS, MALCOLM SR
Entity type:Individual
Prefix:MR
First Name:MALCOLM
Middle Name:
Last Name:WILLIAMS
Suffix:SR
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 1:5319 N 30TH ST APT 318
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-1652
Mailing Address - Country:US
Mailing Address - Phone:531-364-3799
Mailing Address - Fax:
Practice Address - Street 1:5319 N 30TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-1604
Practice Address - Country:US
Practice Address - Phone:531-364-3799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide