Provider Demographics
NPI:1164494860
Name:WILLIAMS, GEORGE JAY IV (AT,C)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:JAY
Last Name:WILLIAMS
Suffix:IV
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BROOKFORD CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-6108
Mailing Address - Country:US
Mailing Address - Phone:864-275-0289
Mailing Address - Fax:
Practice Address - Street 1:3001 N BOULEVARD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-4331
Practice Address - Country:US
Practice Address - Phone:804-359-4444
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260005322255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer