Provider Demographics
NPI:1780441410
Name:WILLIAMS, ASHLEY LAJUAN (MEDICAL WIG SPECIALI)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:LAJUAN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MEDICAL WIG SPECIALI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 E MARTIN PL
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603
Mailing Address - Country:US
Mailing Address - Phone:870-329-0622
Mailing Address - Fax:
Practice Address - Street 1:127 E MARTIN PL
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603
Practice Address - Country:US
Practice Address - Phone:870-329-0622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier