Provider Demographics
NPI:1083290035
Name:WILLIAMS, JOHN KONRAD
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:KONRAD
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 N HALIFAX RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-7819
Mailing Address - Country:US
Mailing Address - Phone:252-200-8176
Mailing Address - Fax:
Practice Address - Street 1:213 S TILLERY ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-5528
Practice Address - Country:US
Practice Address - Phone:252-200-8176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-21
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health