Provider Demographics
NPI:1316924608
Name:WILLIAMS, JAMES GARNER (MD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:GARNER
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:GARNER
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:202 WEST COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1902
Mailing Address - Country:US
Mailing Address - Phone:626-966-2111
Mailing Address - Fax:626-967-6315
Practice Address - Street 1:202 WEST COLLEGE ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1902
Practice Address - Country:US
Practice Address - Phone:626-966-2111
Practice Address - Fax:626-967-6315
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48653207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A486530Medicaid
CAWA48653AMedicare PIN
CA00A486530Medicaid