Healthcare Provider Details

I. General information

NPI: 1720092109
Provider Name (Legal Business Name): JOHN AUTRY WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 KNOLLCROFT RD
LYONS NJ
07939-5001
US

IV. Provider business mailing address

7 MOORHOUSE CT
BRIDGEWATER NJ
08807-5527
US

V. Phone/Fax

Practice location:
  • Phone: 908-647-0180
  • Fax: 908-604-5251
Mailing address:
  • Phone: 908-526-6865
  • Fax: 908-604-5251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMA0526400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: