Provider Demographics
NPI:1629699707
Name:WILLIAMS, AMOS DYRON (CPT)
Entity Type:Individual
Prefix:
First Name:AMOS
Middle Name:DYRON
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1786
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-5786
Mailing Address - Country:US
Mailing Address - Phone:240-383-4800
Mailing Address - Fax:240-846-1533
Practice Address - Street 1:12103 WINDBROOK DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1149
Practice Address - Country:US
Practice Address - Phone:240-383-4800
Practice Address - Fax:240-846-1533
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
37925002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer