Active NPI
Daveeda Gailes Williams, PROVIDER
- Clinical Medical Laboratory
- Texarkana, TX
National Provider Identifier
1245477587
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Medical Laboratory
- License
- NA10017951
- Practice address
- 4618 Verbena St
Texarkana, TX 75503-2154 - Phone
- (903) 276-4210
- Fax
- (430) 200-0403
- NPI assigned
- Jan 8, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health or Welfare Agency | 251K00000X | NA10017951 | TX | |
| Clinical Medical Laboratory | 291U00000X | NA10017951 | TX | Primary |
Addresses
Primary practice location
4618 Verbena St
Texarkana, TX 75503-2154
Mailing address
4618 Verbena St
Texarkana, TX 75503-2154
Phone (903) 276-4210
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NA10017951 | TX | MD | Public Health or Welfare Agency |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231372800000",
"number": "1245477587",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4618 VERBENA ST",
"city": "TEXARKANA",
"state": "TX",
"postal_code": "755032154",
"telephone_number": "903-276-4210",
"fax_number": "430-200-0403"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4618 VERBENA ST",
"city": "TEXARKANA",
"state": "TX",
"postal_code": "755032154",
"telephone_number": "903-276-4210",
"fax_number": "430-200-0403"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMS",
"first_name": "DAVEEDA",
"middle_name": "GAILES",
"name_prefix": "Mrs.",
"credential": "PROVIDER",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-01-08",
"last_updated": "2009-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "251K00000X",
"taxonomy_group": "",
"desc": "Public Health or Welfare",
"state": "TX",
"license": "NA10017951",
"primary": false
},
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": "TX",
"license": "NA10017951",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Texarkana, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.