Provider Demographics
NPI:1558741546
Name:WILLIAMS, ANDREW (ATC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 ROSS RD
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-2440
Mailing Address - Country:US
Mailing Address - Phone:707-304-3100
Mailing Address - Fax:
Practice Address - Street 1:3815 ROSS RD
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-2440
Practice Address - Country:US
Practice Address - Phone:707-304-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer