Provider Demographics
NPI:1447333091
Name:WILLIAMS, PATRICK J (PSYD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4145 COLUMBIA ROAD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907
Mailing Address - Country:US
Mailing Address - Phone:706-869-7373
Mailing Address - Fax:706-869-7380
Practice Address - Street 1:4145 COLUMBIA ROAD
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907
Practice Address - Country:US
Practice Address - Phone:706-869-7373
Practice Address - Fax:706-869-7380
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002945103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59538AMedicare ID - Type UnspecifiedMEDICARE ID#