Healthcare Provider Details

I. General information

NPI: 1225943855
Provider Name (Legal Business Name): JOHN MARK WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 S US HIGHWAY 68
URBANA OH
43078-9470
US

IV. Provider business mailing address

6504 FLETCHER CHAPEL RD
SOUTH CHARLESTON OH
45368-7701
US

V. Phone/Fax

Practice location:
  • Phone: 937-207-6842
  • Fax:
Mailing address:
  • Phone: 937-207-6842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberCL1009918
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: