Provider Demographics
NPI:1265576318
Name:WILLIAMS, DANIEL R
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
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 1:615 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-2194
Mailing Address - Country:US
Mailing Address - Phone:731-925-6578
Mailing Address - Fax:
Practice Address - Street 1:555 PICKWICK ST S
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-3082
Practice Address - Country:US
Practice Address - Phone:731-925-1152
Practice Address - Fax:731-926-3199
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNC2615183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist