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1396141974

NPI Code Detail

MEDICARE: MR. JOHN RICHARD WILLIAMS I PA-C

MEDICARE: MR. JOHN RICHARD WILLIAMS I PA-C

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	363A00000X	Physician Assistant
2	363A00000X	Physician Assistant	0010-13479	NC
3	363AS0400X	Surgical Physician Assistant	007425	GA
4	363A00000X	Physician Assistant	7425	GA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	06705493	OTHER	GA	AMERIGROUP
4	1819077	OTHER	GA	WELLCARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396141974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN RICHARD WILLIAMS I PA-C

Provider Business Mailing Address
First Line	:	189 BO JAMES ST STE 105
Second Line	:
City	:	CLAYTON
State	:	GA
Zip	:	30525-6199
Country	:	US
Telephone Number	:	706-782-0016
Fax Number	:	706-782-0180

Provider Business Practice Location Address
First Line	:	189 BO JAMES ST STE 105
Second Line	:
City	:	CLAYTON
State	:	GA
Zip	:	30525-6199
Country	:	US
Telephone Number	:	706-782-0016
Fax Number	:	706-782-0180

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

Provider Enumeration Date	:	11/10/2014
Last Update Date	:	06/05/2024

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Directions to “ MR. JOHN RICHARD WILLIAMS I PA-C” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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