Provider Demographics
NPI:1033184056
Name:WILLIAMS, DAVID JOHN (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOHN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 NOCATEE TRL
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3611
Mailing Address - Country:US
Mailing Address - Phone:678-494-5920
Mailing Address - Fax:678-238-0352
Practice Address - Street 1:3353 TRICKUM RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4234
Practice Address - Country:US
Practice Address - Phone:770-517-1456
Practice Address - Fax:678-238-0352
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA6463111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52821133001OtherBLUECROSS/BLUESHIELD
GA52821133001OtherBLUECROSS/BLUESHIELD