Provider Demographics
NPI:1639415193
Name:WILLIAMS, GREGORY WALTON (MS)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:WALTON
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 BOYDS SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-8583
Mailing Address - Country:US
Mailing Address - Phone:717-334-4550
Mailing Address - Fax:
Practice Address - Street 1:19844 BLUERIDGE MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:MOUNT WEATHER
Practice Address - State:VA
Practice Address - Zip Code:20135-2006
Practice Address - Country:US
Practice Address - Phone:540-542-3986
Practice Address - Fax:540-542-3065
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA090599146L00000X
VAE081610702146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic