Provider Demographics
NPI:1174230288
Name:WILLIAMS, URIAH JORDAN SR
Entity type:Individual
Prefix:
First Name:URIAH
Middle Name:JORDAN
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 1:3808 EXETER LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2419
Mailing Address - Country:US
Mailing Address - Phone:813-892-8598
Mailing Address - Fax:800-507-6586
Practice Address - Street 1:3808 EXETER LN
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-2419
Practice Address - Country:US
Practice Address - Phone:813-892-8598
Practice Address - Fax:800-507-6586
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy