Provider Demographics
NPI:1538043567
Name:WILLIAMS, ADDISSON RANDALL
Entity type:Individual
Prefix:
First Name:ADDISSON
Middle Name:RANDALL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19432 KISTLER FARM RD
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-9007
Mailing Address - Country:US
Mailing Address - Phone:704-918-8868
Mailing Address - Fax:
Practice Address - Street 1:19432 KISTLER FARM RD
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-9007
Practice Address - Country:US
Practice Address - Phone:704-918-8868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer