Provider Demographics
NPI:1639235336
Name:JONATHAN WAYNE WILLIAMS MD
Entity Type:Organization
Organization Name:JONATHAN WAYNE WILLIAMS MD
Other - Org Name:CHRISTIAN FAMILY HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNERMEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-569-1177
Mailing Address - Street 1:312 S AVENUE D
Mailing Address - Street 2:
Mailing Address - City:BURKBURNETT
Mailing Address - State:TX
Mailing Address - Zip Code:76354-3564
Mailing Address - Country:US
Mailing Address - Phone:940-569-1177
Mailing Address - Fax:940-569-4969
Practice Address - Street 1:312 S AVENUE D
Practice Address - Street 2:
Practice Address - City:BURKBURNETT
Practice Address - State:TX
Practice Address - Zip Code:76354-3564
Practice Address - Country:US
Practice Address - Phone:940-569-1177
Practice Address - Fax:940-569-4969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0097JYOtherBCBSTX GRP
TX0097JYOtherBCBSTX GRP