Provider Demographics
NPI:1467404657
Name:WILLIAMS, JAMES DEWEY (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DEWEY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 GRANDVIEW AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2517
Mailing Address - Country:US
Mailing Address - Phone:203-578-4630
Mailing Address - Fax:203-579-4629
Practice Address - Street 1:171 GRANDVIEW AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2517
Practice Address - Country:US
Practice Address - Phone:203-578-4630
Practice Address - Fax:203-579-4629
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300429207Y00000X
CT55595207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891335AMedicaid
NC2016199Medicare PIN
NC891335AMedicaid