MEDICARE: DR. ARTHUR DARRELL WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	2327	WA
2	103G00000X	Clinical Neuropsychologist	PSY6047	CA

General Provider Information

NPI Number	:	1306984695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARTHUR DARRELL WILLIAMS

Provider Business Mailing Address
First Line	:	7770 REGENTS RD # 113-559
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-1937
Country	:	US
Telephone Number	:	858-458-5909
Fax Number	:	858-458-5910

Provider Business Practice Location Address
First Line	:	7770 REGENTS RD # 113-559
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-1937
Country	:	US
Telephone Number	:	858-458-5909
Fax Number	:	858-458-5910

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	10/21/2016

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