Healthcare Provider Details

I. General information

NPI: 1831014760
Provider Name (Legal Business Name): MITCHEL WILLIAMS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 16TH ST STE 300
WHEELING WV
26003-3610
US

IV. Provider business mailing address

103 JAIME LN
FOLLANSBEE WV
26037-1268
US

V. Phone/Fax

Practice location:
  • Phone: 304-231-2090
  • Fax:
Mailing address:
  • Phone: 304-374-6917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: