Healthcare Provider Details

I. General information

NPI: 1346711207
Provider Name (Legal Business Name): LAUREN WILLIAMS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16890 FOREST RD
FOREST VA
24551
US

IV. Provider business mailing address

16890 FOREST RD
FOREST VA
24551-4059
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-7210
  • Fax:
Mailing address:
  • Phone: 434-200-7210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110-0065421
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number0110-0065421
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: