Provider Demographics
NPI:1821209875
Name:WILLIAMS, JASON JAMES (IDC)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:JAMES
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:509 CORBIN ST
Mailing Address - Street 2:APT D2
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-7828
Mailing Address - Country:US
Mailing Address - Phone:910-353-6547
Mailing Address - Fax:
Practice Address - Street 1:1ST BATTALION, 9TH MARINES
Practice Address - Street 2:PSC BOX 20112
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28542-0112
Practice Address - Country:US
Practice Address - Phone:910-450-6389
Practice Address - Fax:910-450-6397
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman