Provider Demographics
NPI:1437886348
Name:WILLIAMS, ANTOINETTE SHANAE' (PA-C)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:SHANAE'
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 ASHLAKE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-2827
Mailing Address - Country:US
Mailing Address - Phone:804-256-8282
Mailing Address - Fax:
Practice Address - Street 1:2035 WATERSIDE RD STE 105
Practice Address - Street 2:
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875-1265
Practice Address - Country:US
Practice Address - Phone:804-256-8282
Practice Address - Fax:804-256-8288
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110008588207Q00000X, 207R00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine