Tina Michelle Williams, PA-C

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

5601003406 Issued in MI

Practice address

2950 Keewahdin Rd
Fort Gratiot, MI 48059-3526

Phone

(810) 455-1600

Fax

(810) 455-1620

NPI assigned

Aug 1, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556582400000",
    "number": "1588671978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43151 DALCOMA DR STE 4",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480386306",
            "telephone_number": "586-286-8720",
            "fax_number": "586-649-6699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2950 KEEWAHDIN RD",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593526",
            "telephone_number": "810-455-1600",
            "fax_number": "810-455-1620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "TINA",
        "middle_name": "MICHELLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-01",
        "last_updated": "2019-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "MI",
            "license": "5601003406",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jade Whitmore
• Max Jared Whittredge
• Veronica Wickman, COTAL
• Justin Lloyd Williams
• Ladora M Williams, RN, LMFT
• Kimberley Lee Williamson
• Alyssa Courtney Wilson
• Nissa Nichole Wilson
• Laura Winkelman, NP-C
• Kayleigh Winters

• Dermatology Physician in Fort Gratiot, MI
• Providers in Fort Gratiot, MI by specialty
• Dermatology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2019; 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.