Provider Demographics
NPI:1720305279
Name:WILLIAMS, BILL ALLEN
Entity type:Individual
Prefix:
First Name:BILL
Middle Name:ALLEN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:VA
Mailing Address - Zip Code:22572-5216
Mailing Address - Country:US
Mailing Address - Phone:804-472-7020
Mailing Address - Fax:877-655-9886
Practice Address - Street 1:27 MARION WAY
Practice Address - Street 2:
Practice Address - City:HAGUE
Practice Address - State:VA
Practice Address - Zip Code:22469
Practice Address - Country:US
Practice Address - Phone:804-472-4260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-23
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1930Medicaid