Healthcare Provider Details

I. General information

NPI: 1669160677
Provider Name (Legal Business Name): SARAH WILLIAMS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 09/27/2024
Certification Date: 09/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 W EMMITT AVE
WAVERLY OH
45690-1190
US

IV. Provider business mailing address

1735 27TH ST STE B06
PORTSMOUTH OH
45662-2681
US

V. Phone/Fax

Practice location:
  • Phone: 740-947-7662
  • Fax: 740-941-0099
Mailing address:
  • Phone: 740-356-8681
  • Fax: 740-356-1256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.008516RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: