Provider Demographics
NPI:1225016439
Name:WILLIAMS, THOMAS M (PA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:WILLIAMS
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Gender:M
Credentials:PA
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Mailing Address - Street 1:1204 MASSEY AVE.
Mailing Address - Street 2:NBHC FAMILY PRACTICE
Mailing Address - City:MAYPORT
Mailing Address - State:FL
Mailing Address - Zip Code:32228-0000
Mailing Address - Country:US
Mailing Address - Phone:904-270-4220
Mailing Address - Fax:904-270-4448
Practice Address - Street 1:1204 MASSEY AVE.
Practice Address - Street 2:NBHC FAMILY PRACTICE
Practice Address - City:MAYPORT
Practice Address - State:FL
Practice Address - Zip Code:32228-0000
Practice Address - Country:US
Practice Address - Phone:904-270-4220
Practice Address - Fax:904-270-4448
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2016-11-17
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN