Provider Demographics
NPI:1073567061
Name:WILLIAMS, MICHAEL DONALD (M D)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DONALD
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5755 N POINT PKWY
Mailing Address - Street 2:SUITE 223
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1171
Mailing Address - Country:US
Mailing Address - Phone:770-500-3660
Mailing Address - Fax:770-500-3664
Practice Address - Street 1:5755 N POINT PKWY
Practice Address - Street 2:SUITE 223
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1171
Practice Address - Country:US
Practice Address - Phone:770-500-3660
Practice Address - Fax:770-500-3664
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA51419208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
02BBGHPMedicare ID - Type UnspecifiedMEDICARE
GAH71857Medicare UPIN