Provider Demographics
NPI:1770668774
Name:C DONALD WILLIAMS MD PS
Entity Type:Organization
Organization Name:C DONALD WILLIAMS MD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-457-4611
Mailing Address - Street 1:402 E YAKIMA AVE
Mailing Address - Street 2:#330
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-2755
Mailing Address - Country:US
Mailing Address - Phone:509-457-4611
Mailing Address - Fax:509-454-3295
Practice Address - Street 1:402 E YAKIMA AVE
Practice Address - Street 2:#330
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-2755
Practice Address - Country:US
Practice Address - Phone:509-457-4611
Practice Address - Fax:509-454-3295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0004691OtherDEPT OF LABOR & INDUSTRIE
A06615Medicare UPIN