Provider Demographics
NPI:1689663825
Name:WILLIAMS, HOWARD JAMIE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:JAMIE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MEDICAL DR NE STE 101
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-8005
Mailing Address - Country:US
Mailing Address - Phone:770-386-5221
Mailing Address - Fax:770-382-2794
Practice Address - Street 1:15 MEDICAL DR NE STE 101
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121
Practice Address - Country:US
Practice Address - Phone:770-386-5221
Practice Address - Fax:770-386-1128
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003775363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA97BBHFROtherMEDICARE PTAN
GA198866572AMedicaid
GAP41497Medicare UPIN
GA198866572AMedicaid