Provider Demographics
NPI:1578914214
Name:WILLIAMS, MARY GOODWIN (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:GOODWIN
Last Name:WILLIAMS
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Gender:F
Credentials:MPAS, PA-C
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Mailing Address - Street 1:2940 E BANNER GATEWAY DR STE 450
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2178
Mailing Address - Country:US
Mailing Address - Phone:303-519-8999
Mailing Address - Fax:
Practice Address - Street 1:2946 E BANNER GATEWAY DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2165
Practice Address - Country:US
Practice Address - Phone:480-256-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2019-06-13
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant