Provider Information for 1154452019
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DERRICK L WILLIAMS
Sex: Male
NPI: 1154452019
Last Updated: 2024-05-08
Certification Date: 2024-04-30
Certification Date: 2024-04-30
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1154452019 | ||||||||||||
| Enumeration Date | 2007-03-09 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 106 SPRINGVIEW LN SUMMERVILLE, SC 29485-8108 United States Phone: | Fax: | ||||||||||||
| Primary Practice Address | 19 MEADOWOOD DRIVE LANGHORNE, PA 19047-1616 United States Phone: 215-750-4004 | Fax:215-750-4322 | ||||||||||||
| Secondary Practice Address(es) | 106 SPRINGVIEW LN | ||||||||||||
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