Provider Demographics
NPI:1881463602
Name:WILLIAMS, DEANDRA (PA)
Entity type:Individual
Prefix:
First Name:DEANDRA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2200 W MAIN STREET
Mailing Address - Street 2:STE 520- OFFICE 5204
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-2542
Mailing Address - Country:US
Mailing Address - Phone:919-681-7255
Mailing Address - Fax:919-681-8856
Practice Address - Street 1:2200 W MAIN STREET
Practice Address - Street 2:STE 520- OFFICE 5204
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-2542
Practice Address - Country:US
Practice Address - Phone:919-681-7255
Practice Address - Fax:919-681-8856
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-20
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-14775363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty