Provider Demographics
NPI:1255587069
Name:WILLIAMS, JEFFREY (PHD, ATC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PHD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1097 LAZIO CT
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-6352
Mailing Address - Country:US
Mailing Address - Phone:708-267-1938
Mailing Address - Fax:
Practice Address - Street 1:101 BRANIGIN BLVD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2598
Practice Address - Country:US
Practice Address - Phone:708-267-1938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960026272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer