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General NPI Number Information
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NPI Number | 1013254960
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Entity Type | Individual
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Provider Name | MATTHEW S WILLIAMS ATC
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Gender | Male
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Dates
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Enumeration Date | 01/12/2013
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Last Update Date | 01/12/2013
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Provider Practice Location Address
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Address Line | 1 HAYDEN DR ATHLETIC DEPARTMENT
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City | PETERSBURG
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State | VA
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Zip | 23806-1000
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Country | US
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Telephone | 804-524-6798
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Fax | 804-524-8344
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Provider Business Mailing Address
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Address Line | 42 ROLLINGWOOD DR
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City | LAWRENCEVILLE
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State | VA
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Zip | 23868-2125
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Country | US
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Telephone | 434-532-5039
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0126000297
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License Number State | VA
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