Provider Demographics
NPI:1346916822
Name:WILLIAMS, JARED DAVID (BS)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:DAVID
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7438 TEXAS HIGHWAY 8 S
Mailing Address - Street 2:
Mailing Address - City:MAUD
Mailing Address - State:TX
Mailing Address - Zip Code:75567-4589
Mailing Address - Country:US
Mailing Address - Phone:903-293-0068
Mailing Address - Fax:
Practice Address - Street 1:3900 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75799-6600
Practice Address - Country:US
Practice Address - Phone:903-566-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program