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NPI Code Detail

MEDICARE: MR. KEVIN JOSEPH WILLIAMS MS, ATC, CSCS

MEDICARE: MR. KEVIN JOSEPH WILLIAMS MS, ATC, CSCS
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
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1467596809
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. KEVIN JOSEPH WILLIAMS MS, ATC, CSCS
Provider Business Mailing Address
First Line : 2 CLOVERLEAF CIR
Second Line :
City : MALDEN
State : WV
Zip : 25306-6542
Country : US
Telephone Number : 304-925-7605
Fax Number :
Provider Business Practice Location Address
First Line : 200 TRACY WAY
Second Line : NORTHGATE BUSINESS PARK
City : CHARLESTON
State : WV
Zip : 25311-1258
Country : US
Telephone Number : 304-388-4900
Fax Number : 304-388-4910
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2007
Last Update Date : 07/08/2007

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