Healthcare Provider Details

I. General information

NPI: 1356881700
Provider Name (Legal Business Name): MR. JAMES ROBERT WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2017
Last Update Date: 03/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 TIFFANY LN
HAMPTON VA
23664-2058
US

IV. Provider business mailing address

15 TIFFANY LN
HAMPTON VA
23664-2058
US

V. Phone/Fax

Practice location:
  • Phone: 757-243-1008
  • Fax: 757-500-2669
Mailing address:
  • Phone: 757-243-1008
  • Fax: 757-500-2669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberE23849876
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: