John Donald Williams, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PS004377L Issued in PA

Practice address

1315 W College Ave
Suite 303
State College, PA 16801-2776

Phone

(814) 441-5738

Fax

(814) 861-5163

NPI assigned

Oct 15, 2009

Last updated

Jun 28, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Jack D. Williams Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1255564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340841600000",
    "number": "1467787093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1315 W COLLEGE AVE",
            "address_2": "SUITE 303",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168012776",
            "telephone_number": "814-441-5738",
            "fax_number": "814-861-5163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 W COLLEGE AVE",
            "address_2": "SUITE 303",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168012776",
            "telephone_number": "814-441-5738",
            "fax_number": "814-861-5163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "JOHN",
        "middle_name": "DONALD",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-10-15",
        "last_updated": "2012-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS004377L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACK",
            "last_name": "WILLIAMS",
            "middle_name": "D.",
            "prefix": "DR.",
            "credential": "PH.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Robert Marshall Wild Jr., M.D.
• Erica Wiley, PHD
• James R Wilkes Jr., ATC
• Ben Graham Williams, DMD
• Courtney Renee Williams
• Kelsey Williams
• Shyanne Katherine Williams, PA-C
• Patrick Wills Jr.
• Suzanne D. Wills, PH.D.
• Gregory J Wilson, DO

• Clinical Psychologist in State College, PA
• Providers in State College, PA by specialty
• Clinical Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.