Provider Demographics
NPI:1821293838
Name:WILLIAMS, JAMIE A (PT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 813
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-0813
Mailing Address - Country:US
Mailing Address - Phone:256-259-4440
Mailing Address - Fax:256-259-4462
Practice Address - Street 1:102 MICAH WAY
Practice Address - Street 2:SUITE 1105
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35769-4160
Practice Address - Country:US
Practice Address - Phone:256-259-4440
Practice Address - Fax:256-259-4462
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3760225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051525696Medicare ID - Type Unspecified