Provider Demographics
NPI:1215054242
Name:WILLIAMS, JAMES CLARK JR (PT, CSCS, CPED)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:CLARK
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:PT, CSCS, CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 W STUART DR
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-2114
Mailing Address - Country:US
Mailing Address - Phone:276-238-8900
Mailing Address - Fax:276-238-8904
Practice Address - Street 1:106 W STUART DR
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-2114
Practice Address - Country:US
Practice Address - Phone:276-238-8900
Practice Address - Fax:276-238-8904
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305005319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist