Provider Demographics
NPI:1417287681
Name:WILLIAMS, PAULA A (MS,RD,LDN)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS,RD,LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 MCCONNELL ST
Mailing Address - Street 2:PO BOX 208
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-9772
Mailing Address - Country:US
Mailing Address - Phone:336-246-9449
Mailing Address - Fax:336-246-8163
Practice Address - Street 1:413 MCCONNELL ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640-9772
Practice Address - Country:US
Practice Address - Phone:336-246-9449
Practice Address - Fax:336-246-8163
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL002803133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered