1124005285 NPI number — AMANDA ELIZABETH WILLIAMS MD

Table of content: AMANDA ELIZABETH WILLIAMS MD (NPI 1124005285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124005285 NPI number — AMANDA ELIZABETH WILLIAMS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
AMANDA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VINES
Provider Other First Name:
AMANDA
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124005285
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5555 GLENRIDGE CONNECTOR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30342-4815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
470-575-4321
Provider Business Mailing Address Fax Number:
469-281-0986

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5555 GLENRIDGE CONNECTOR STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30342-4815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
470-575-4321
Provider Business Practice Location Address Fax Number:
469-281-0986
Provider Enumeration Date:
12/29/2005

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: 2084P0800X , with the licence number:  63049 , 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)

  • Identifier: 1144401464 . This is a "PRACTICE LOCATION NPI GROUP NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 9338635 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1841239274 . This is a "MEDICARE NPI GROUP NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2328270 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2774985 . This is a "MEDICAID GROUP NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".