Healthcare Provider Details

I. General information

NPI: 1255587069
Provider Name (Legal Business Name): JEFFREY WILLIAMS PHD, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BRANIGIN BLVD
FRANKLIN IN
46131-2598
US

IV. Provider business mailing address

1097 LAZIO CT
GREENWOOD IN
46143-6352
US

V. Phone/Fax

Practice location:
  • Phone: 708-267-1938
  • Fax:
Mailing address:
  • Phone: 708-267-1938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096002627
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: