Provider Demographics
NPI:1396065827
Name:WILLIAMS, MATHEW WADE (PA-C)
Entity type:Individual
Prefix:
First Name:MATHEW
Middle Name:WADE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3001 LYNDHURST AVE
Mailing Address - Street 2:SALEM CHEST SPECIALISTS
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4007
Mailing Address - Country:US
Mailing Address - Phone:336-765-0383
Mailing Address - Fax:336-768-1737
Practice Address - Street 1:3001 LYNDHURST AVE
Practice Address - Street 2:SALEM CHEST SPECIALISTS
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4007
Practice Address - Country:US
Practice Address - Phone:336-765-0383
Practice Address - Fax:336-768-1737
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-02328363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2762344Medicare PIN