Provider Demographics
NPI:1346343159
Name:BATTLE-WILLIAMS, LYDIA ANN (PA)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:ANN
Last Name:BATTLE-WILLIAMS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:251 EASTWAY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-7103
Practice Address - Country:US
Practice Address - Phone:704-446-9991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103395363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1346343159Medicaid
NC8102332Medicaid
NC2344402IMedicare PIN
NC1346343159Medicaid
NC2755849DMedicare PIN
NCNC4814CMedicare PIN
NC2344402RMedicare PIN
NC2344402GMedicare PIN
NC2755849QMedicare PIN
NC2344402AMedicare PIN
NC2344402EMedicare PIN
NC2344402HMedicare PIN
NC2344402LMedicare PIN
NC2344402NMedicare PIN
NCNC4814BMedicare PIN
NC2344402KMedicare PIN
NC2755849SMedicare PIN
NC2344402JMedicare PIN
NC2344402MMedicare PIN
NC2344402PMedicare PIN
NCNC4814AMedicare PIN
NC2344402DMedicare PIN