Provider Demographics
NPI:1629415476
Name:WILLIAMS, JON P (DO, PHD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:P
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 MIAMI VALLEY DR STE 550
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-1298
Mailing Address - Country:US
Mailing Address - Phone:937-438-7500
Mailing Address - Fax:
Practice Address - Street 1:2300 MIAMI VALLEY DR STE 550
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-1298
Practice Address - Country:US
Practice Address - Phone:937-438-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-03
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004573A2084N0400X, 171000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No171000000XOther Service ProvidersMilitary Health Care Provider
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program