Healthcare Provider Details

I. General information

NPI: 1306072046
Provider Name (Legal Business Name): JAMES DALE WILLIAMSON JR. PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 COFFEE RD STE I
MODESTO CA
95355-2360
US

IV. Provider business mailing address

2209 COFFEE RD STE I
MODESTO CA
95355-2360
US

V. Phone/Fax

Practice location:
  • Phone: 209-526-6400
  • Fax: 209-637-2834
Mailing address:
  • Phone: 209-526-6400
  • Fax: 209-637-2834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: