Provider Demographics
NPI:1851378855
Name:WILLIAMS, PAUL WAYNE (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:WAYNE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 MIDDLEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-8796
Mailing Address - Country:US
Mailing Address - Phone:336-712-1000
Mailing Address - Fax:888-882-8048
Practice Address - Street 1:2850 MIDDLEBROOK DR
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8796
Practice Address - Country:US
Practice Address - Phone:336-712-1000
Practice Address - Fax:888-882-8048
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2119111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790892CMedicaid
NC2449168Medicare ID - Type Unspecified
NCU54662Medicare UPIN