Provider Demographics
NPI:1497919609
Name:WILLIAMS, ALICIA MICHELE (PA)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MICHELE
Last Name: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 1:271 MCCOY RD W
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49735-8253
Mailing Address - Country:US
Mailing Address - Phone:989-731-7708
Mailing Address - Fax:989-731-7929
Practice Address - Street 1:1996 WALDEN DR
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-8241
Practice Address - Country:US
Practice Address - Phone:989-731-4111
Practice Address - Fax:989-705-8511
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5601005340OtherMI LICENSE
OF96004OtherMEDICARE GROUP NUMBER