Provider Demographics
NPI:1831800648
Name:WILLIAMS, BRENTTON ST JAMES
Entity type:Individual
Prefix:
First Name:BRENTTON
Middle Name:ST JAMES
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 1:129 MOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45426-3008
Mailing Address - Country:US
Mailing Address - Phone:937-432-8827
Mailing Address - Fax:
Practice Address - Street 1:129 MOLLY AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45426-3008
Practice Address - Country:US
Practice Address - Phone:937-432-8827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health