1235131525 NPI number — DENNIS A WILLIAMS MD

Table of content: DENNIS A WILLIAMS MD (NPI 1235131525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235131525 NPI number — DENNIS A WILLIAMS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
DENNIS
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235131525
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4409 EVANS TO LOCKS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30809-3603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-396-7671
Provider Business Mailing Address Fax Number:
706-396-7676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4409 EVANS TO LOCKS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVANS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30809-3603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-396-7671
Provider Business Practice Location Address Fax Number:
706-396-7676
Provider Enumeration Date:
06/01/2005

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: 2081P2900X , with the licence number:  GA38402 , 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: 00616756B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009938356 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".