Provider Demographics
NPI:1609949288
Name:WILLIAMS, JASON ANTHONY (PA)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ANTHONY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 CLARENDON ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-4847
Mailing Address - Country:US
Mailing Address - Phone:910-237-9483
Mailing Address - Fax:919-562-7401
Practice Address - Street 1:2001 S MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-1612
Practice Address - Country:US
Practice Address - Phone:919-562-3155
Practice Address - Fax:919-562-7401
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102539208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP10067Medicare UPIN
NC275288EMedicare PIN
NC275288GMedicare PIN