=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619055829
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID H WILLIAMS PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2006
-----------------------------------------------------
Last Update Date | 11/11/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9500 EUCLID AVE DESK S40
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44195-8320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-636-5860
-----------------------------------------------------
Fax | 216-636-2607
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3975 EMBASSY PKWY
-----------------------------------------------------
City | AKRON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44333-8320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-668-4040
-----------------------------------------------------
Fax | 330-668-4078
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number | 50001040
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------