Provider Demographics
NPI:1992911044
Name:WILLIAMS, CLAUDIS ANDRE' JR (PA)
Entity type:Individual
Prefix:MR
First Name:CLAUDIS
Middle Name:ANDRE'
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 24TH ST.
Mailing Address - Street 2:KENNER ARMY HEALTH CLINIC
Mailing Address - City:FT. LEE
Mailing Address - State:VA
Mailing Address - Zip Code:23801
Mailing Address - Country:US
Mailing Address - Phone:804-734-6474
Mailing Address - Fax:
Practice Address - Street 1:700 24TH ST.
Practice Address - Street 2:KENNER ARMY HEALTH CLINIC
Practice Address - City:FT. LEE
Practice Address - State:VA
Practice Address - Zip Code:23801
Practice Address - Country:US
Practice Address - Phone:804-734-6474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110000819363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant