Individual
MR. BRADLEY WARD WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2331 FRANKLIN RD SW, ROANOKE, VA 24014-1111
(540) 725-1226
(540) 857-5306
Mailing address
213 S JEFFERSON ST STE 1006, ROANOKE, VA 24011-1713
(540) 224-5715
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110840740
VA
363AS0400X
Surgical Physician Assistant
0110840740
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1851379655
OPTIMA HEALTH PLAN
VA
05
—
1851379655
—
VA
01
—
1851679655
HUMANA MEDICARE
VA
01
—
371194700
BLACK LUNG
VA
01
—
540506332108
TRICARE/CHAMPUS
VA
01
—
P00831117
RAILROAD MEDICARE
VA
Enumeration date
01/03/2006
Last updated
09/11/2023
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