Basic Information
| Provider Information | |||||||||
| NPI: | 1184838393 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LENERT-WILLIAMS | ||||||||
| FirstName: | CARMELL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9300 MANSFIELD RD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711183155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186293763 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9300 MANSFIELD RD | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711183155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186293763 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2007 | ||||||||
| LastUpdateDate: | 06/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD.203095 | LA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | P2480 | TX | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 174400000X | MD20395 | LA | N | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 1888389 | 05 | LA | MEDICAID |