Provider Demographics
NPI:1144873225
Name:WILLIAMS, EMILY AMANDA (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:AMANDA
Last Name:WILLIAMS
Suffix:
Gender:F
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 1:11 INTERLAKEN RD
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06039-2141
Mailing Address - Country:US
Mailing Address - Phone:860-280-8763
Mailing Address - Fax:
Practice Address - Street 1:167 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:CT
Practice Address - Zip Code:06489-2505
Practice Address - Country:US
Practice Address - Phone:860-426-0252
Practice Address - Fax:860-426-0458
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4517363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant