Provider Demographics
NPI:1063485001
Name:WILLIAMS, DANA RAY (PA-C)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:RAY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2137 LAKESIDE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-6806
Mailing Address - Country:US
Mailing Address - Phone:434-845-4175
Mailing Address - Fax:434-385-9616
Practice Address - Street 1:2137 LAKESIDE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-6806
Practice Address - Country:US
Practice Address - Phone:434-845-4175
Practice Address - Fax:434-385-9616
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101941363A00000X
VA0110840307363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1063485001Medicaid
VAP00603322OtherMEDICARE RAILROAD
VA017036L84Medicare PIN
VAP00603322OtherMEDICARE RAILROAD
S63676Medicare UPIN