Provider Demographics
NPI:1710299979
Name:WILLIAMS, VIRGINIA ELIZABETH (MED, ATC-L)
Entity Type:Individual
Prefix:MISS
First Name:VIRGINIA
Middle Name:ELIZABETH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MED, ATC-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:115 S SAINT MARYS ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-1699
Mailing Address - Country:US
Mailing Address - Phone:180-036-2090
Mailing Address - Fax:186-643-4509
Practice Address - Street 1:115 S SAINT MARYS ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27603-1699
Practice Address - Country:US
Practice Address - Phone:180-036-2090
Practice Address - Fax:186-643-4509
Is Sole Proprietor?:No
Enumeration Date:2010-07-05
Last Update Date:2010-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer