Provider Demographics
NPI:1487899746
Name:WILLIAMS, CHARLES (CPO)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7384
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39282-7384
Mailing Address - Country:US
Mailing Address - Phone:601-502-2222
Mailing Address - Fax:601-502-2244
Practice Address - Street 1:1300 HUDSON LN
Practice Address - Street 2:SUITE 6
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-6066
Practice Address - Country:US
Practice Address - Phone:318-699-9025
Practice Address - Fax:318-699-9012
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management