Healthcare Provider Details

I. General information

NPI: 1659771269
Provider Name (Legal Business Name): JOHN DONALD WILLIAMS III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2014
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 INTERNATIONAL DR
SILVER SPRING MD
20906-1501
US

IV. Provider business mailing address

2416 LADYMEADE DR
SILVER SPRING MD
20906-5741
US

V. Phone/Fax

Practice location:
  • Phone: 301-438-3023
  • Fax: 301-438-3024
Mailing address:
  • Phone: 240-793-1610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA4164
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: