Healthcare Provider Details

I. General information

NPI: 1164497509
Provider Name (Legal Business Name): DEBBIE L WILLIAMS P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 E BROAD ST
MANSFIELD TX
76063-5899
US

IV. Provider business mailing address

2700 E BROAD ST
MANSFIELD TX
76063-5899
US

V. Phone/Fax

Practice location:
  • Phone: 214-947-2874
  • Fax: 214-947-2884
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number12233
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA2311
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA03689
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: