Provider Demographics
NPI:1659771269
Name:WILLIAMS, JOHN DONALD III
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DONALD
Last Name:WILLIAMS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 LADYMEADE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-5741
Mailing Address - Country:US
Mailing Address - Phone:240-793-1610
Mailing Address - Fax:
Practice Address - Street 1:3700 INTERNATIONAL DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-1501
Practice Address - Country:US
Practice Address - Phone:301-438-3023
Practice Address - Fax:301-438-3024
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA4164225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant