Provider Demographics
NPI:1447974563
Name:WILLIAMS, JONATHAN BLYTHE (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:BLYTHE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2300 MANCHESTER EXPY STE 2001A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-6802
Mailing Address - Country:US
Mailing Address - Phone:706-320-3126
Mailing Address - Fax:706-320-3054
Practice Address - Street 1:66 HOMEWOODS LN
Practice Address - Street 2:
Practice Address - City:PROSPERITY
Practice Address - State:SC
Practice Address - Zip Code:29127-8800
Practice Address - Country:US
Practice Address - Phone:803-318-3611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2024-08-07
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical