Provider Demographics
NPI:1770548562
Name:WILLIAMS, JOHN CHARLES (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CHARLES
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 ROSALINE AVE STE F
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2543
Mailing Address - Country:US
Mailing Address - Phone:530-244-3338
Mailing Address - Fax:530-244-3342
Practice Address - Street 1:1950 ROSALINE AVE STE F
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2543
Practice Address - Country:US
Practice Address - Phone:530-244-3338
Practice Address - Fax:530-244-3342
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00E20300213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4044019Medicaid
CAT11142Medicare UPIN
000E20300Medicare ID - Type Unspecified