Provider Demographics
NPI:1023880069
Name:WILLIAMS, ANTRONE JUICE
Entity type:Individual
Prefix:
First Name:ANTRONE
Middle Name:JUICE
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 1:240 21ST ST APT 812
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-5150
Mailing Address - Country:US
Mailing Address - Phone:419-315-5054
Mailing Address - Fax:
Practice Address - Street 1:240 21ST ST APT 812
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-5150
Practice Address - Country:US
Practice Address - Phone:419-315-5054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver