Provider Demographics
NPI:1821055799
Name:WILLIAMS, ALLISON (PA-C)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:GOETTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:25 COLONY BOULEVARD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-7971
Mailing Address - Country:US
Mailing Address - Phone:724-459-9111
Mailing Address - Fax:724-459-7856
Practice Address - Street 1:25 COLONY BOULEVARD
Practice Address - Street 2:SUITE 102
Practice Address - City:BLAIRSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15717-7971
Practice Address - Country:US
Practice Address - Phone:724-459-9111
Practice Address - Fax:724-459-7856
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051052363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP87845Medicare UPIN
PA069256Medicare PIN