Provider Demographics
NPI:1083137525
Name:WILLIAMS, WALTER WENDELL (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:WENDELL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6051 ROCK SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-1508
Mailing Address - Country:US
Mailing Address - Phone:404-218-0698
Mailing Address - Fax:404-235-1751
Practice Address - Street 1:6051 ROCK SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-1508
Practice Address - Country:US
Practice Address - Phone:404-218-0698
Practice Address - Fax:404-235-1751
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA21443207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty