E P Ted Williams Mdpa
Psychiatry & Neurology, Psychiatry in San Antonio, TX. Organization (NPI-2).
NPI number1518190859
StatusActive
Last updated in NPPESMay 14, 2025
Details
- NPI
- 1518190859
- Entity type
- Organization (NPI-2)
- Legal business name
- E P Ted Williams Mdpa
- Organization subpart
- No
- Enumeration date
- Sep 3, 2009
- Certification date
- Apr 22, 2025
- Last updated
- May 14, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology, Psychiatry | G3912 | TX | Yes |
| 2084P0804X | Psychiatry & Neurology, Child & Adolescent Psychiatry | G3912 | TX | |
| 261QM1300X | Clinic/Center, Multi-Specialty | – | – |
Other names
- Genesis Behavioral Health (Doing Business As)
Practice location
7122 Stonewall HlSan Antonio, TX 78256-1926
Phone 210-404-9696 · Fax 210-404-9466
Mailing address
7122 Stonewall HlSan Antonio, TX 78256-1926
Phone 210-404-9696 · Fax 210-404-9466
Authorized official
Edmund Payne Williams
Owner
2104049696
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