Healthcare Provider Details

I. General information

NPI: 1265681316
Provider Name (Legal Business Name): ANDRIA JYNELLE WILLIAMS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2008
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S BRYN MAWR AVE
BRYN MAWR PA
19010-3121
US

IV. Provider business mailing address

70 LINDSEY AVE
RUNNEMEDE NJ
08078-1731
US

V. Phone/Fax

Practice location:
  • Phone: 484-337-3770
  • Fax:
Mailing address:
  • Phone: 856-371-8093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00217100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA053594
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: