1700249042 NPI number — JUSTIN KYLE WILLIAMS MD

Table of content: MS. JENNIFER LEIGH HOLMES B.S. ED / ITFS (NPI 1912254178)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700249042 NPI number — JUSTIN KYLE WILLIAMS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
JUSTIN
Provider Middle Name:
KYLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700249042
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
580 S AIKEN AVE STE 530
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSBURGH
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15232-1531
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-687-2100
Provider Business Mailing Address Fax Number:
412-687-5883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
580 S AIKEN AVE STE 530
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURGH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15232-1531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-687-2100
Provider Business Practice Location Address Fax Number:
412-687-5883
Provider Enumeration Date:
04/04/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0122X , with the licence number:  83553 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)