Basic Information
| Provider Information | |||||||||
| NPI: | 1255734182 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | HEATH | ||||||||
| MiddleName: | TYRONE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 750 E NORTHERN AVE | ||||||||
| Address2: | 2009 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850204161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4805935452 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3300 N CENTRAL AVE | ||||||||
| Address2: | 2550 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850122501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022562525 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2014 | ||||||||
| LastUpdateDate: | 10/06/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZC0007X | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Certified First Assistant |
No ID Information.