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General NPI Number Information
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NPI Number | 1396141974
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Entity Type | Individual
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Provider Name | JOHN RICHARD WILLIAMS I PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/10/2014
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 189 BO JAMES ST STE 105
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City | CLAYTON
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State | GA
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Zip | 30525-6199
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Country | US
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Telephone | 706-782-0016
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Fax | 706-782-0180
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Provider Business Mailing Address
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Address Line | 189 BO JAMES ST STE 105
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City | CLAYTON
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State | GA
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Zip | 30525-6199
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Country | US
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Telephone | 706-782-0016
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Fax | 706-782-0180
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-13479
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 007425
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 7425
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License Number State | GA
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