Healthcare Provider Details

I. General information

NPI: 1932607447
Provider Name (Legal Business Name): JOSHUA WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

648 INDEPENDENCE PKWY 300
CHESAPEAKE VA
23320
US

IV. Provider business mailing address

500 HARBOUR NORTH DR
CHESAPEAKE VA
23320-6509
US

V. Phone/Fax

Practice location:
  • Phone: 757-776-0790
  • Fax:
Mailing address:
  • Phone: 757-761-1378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number00003975
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: