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Individual

SAMUEL WILLIAMS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
301 RIVERVIEW AVENUE, SUITE 500, NORFOLK, VA 23510-1064
(757) 624-1785
(757) 624-1759
Mailing address
301 RIVERVIEW AVENUE, SUITE 500, NORFOLK, VA 23510-1064
(757) 624-1785
(757) 624-1759

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110001619
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
VAA103569
INDIVIDUAL PTAN
Enumeration date
08/07/2006
Last updated
01/04/2011
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