Healthcare Provider Details

I. General information

NPI: 1285906388
Provider Name (Legal Business Name): ALEXIS L. WILLIAMS MSPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21475 RIDGETOP CIR SUITE 150
STERLING VA
20166-6580
US

IV. Provider business mailing address

21475 RIDGETOP CIR SUITE 150
STERLING VA
20166-6580
US

V. Phone/Fax

Practice location:
  • Phone: 703-444-5000
  • Fax: 703-444-4999
Mailing address:
  • Phone: 703-444-5000
  • Fax: 703-444-4999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110003784
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: