Healthcare Provider Details

I. General information

NPI: 1427486380
Provider Name (Legal Business Name): JARET TERRELL WILLIAMS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2013
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

539 FARMINGTON AVE
BRISTOL CT
06010-3931
US

IV. Provider business mailing address

539 FARMINGTON AVE
BRISTOL CT
06010-3931
US

V. Phone/Fax

Practice location:
  • Phone: 860-314-6046
  • Fax:
Mailing address:
  • Phone: 860-314-6046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9120352
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3015
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: