MEDICARE: MR. JOHNATHAN DELEON WILLIAMS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	31957	NC
2	208000000X	Pediatrics Physician	31957	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245201557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHNATHAN DELEON WILLIAMS MD

Provider Business Mailing Address
First Line	:	640 SUMMIT CROSSING PL
Second Line	:	STE 204
City	:	GASTONIA
State	:	NC
Zip	:	28054-2142
Country	:	US
Telephone Number	:	704-865-0626
Fax Number	:	704-865-6531

Provider Business Practice Location Address
First Line	:	640 SUMMIT CROSSING PL
Second Line	:	STE 204
City	:	GASTONIA
State	:	NC
Zip	:	28054-2142
Country	:	US
Telephone Number	:	704-865-0626
Fax Number	:	704-865-6531

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	10/23/2007

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