Healthcare Provider Details

I. General information

NPI: 1568430841
Provider Name (Legal Business Name): RYAN GENTRY WILLIAMS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MT CLEMENT PARK SUITE C
TAPPAHANNOCK VA
22560-5098
US

IV. Provider business mailing address

856 J CLYDE MORRIS BLVD SUITE A
NEWPORT NEWS VA
23601-1318
US

V. Phone/Fax

Practice location:
  • Phone: 804-443-6063
  • Fax: 804-443-6005
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0102201877
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: