Provider Demographics
NPI:1295783165
Name:WILLIAMS, ALISA S (MD)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALISA
Other - Middle Name:REBECCA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 937
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:VA
Mailing Address - Zip Code:23093-0937
Mailing Address - Country:US
Mailing Address - Phone:434-964-7523
Mailing Address - Fax:866-462-7676
Practice Address - Street 1:144 PRISON LANE
Practice Address - Street 2:MENTAL HEALTH
Practice Address - City:TROY
Practice Address - State:VA
Practice Address - Zip Code:22974
Practice Address - Country:US
Practice Address - Phone:434-984-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0383682084P0800X
VA01012390512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
F81409Medicare UPIN
26BDGGF01Medicare ID - Type Unspecified