Basic Information
| Provider Information | |||||||||
| NPI: | 1609949288 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1010 CLARENDON ST | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283054847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102379483 | ||||||||
| FaxNumber: | 9195627401 | ||||||||
| Practice Location | |||||||||
| Address1: | 2001 S MAIN ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | WAKE FOREST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275871612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195623155 | ||||||||
| FaxNumber: | 9195627401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2006 | ||||||||
| LastUpdateDate: | 04/10/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 102539 | NC | Y | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.