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General NPI Number Information
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NPI Number | 1811013741
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Entity Type | Individual
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Provider Name | TANYA L WILLIAMS P.A.
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Gender | Female
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 11/30/2016
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Provider Practice Location Address
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Address Line | 10650 PARK ROAD SUITE 300
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City | CHARLOTTE
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State | NC
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Zip | 28210-8543
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Country | US
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Telephone | 704-667-3960
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Fax | 704-667-3961
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Provider Business Mailing Address
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Address Line | PO BOX 601643
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City | CHARLOTTE
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State | NC
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Zip | 28260-1643
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Country | US
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Telephone | 704-667-3960
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Fax | 704-667-3961
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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 | 0010-00333
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 724
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License Number State | SC
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