Provider Demographics
NPI:1124005285
Name:WILLIAMS, AMANDA ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ELIZABETH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:ELIZABETH
Other - Last Name:VINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5555 GLENRIDGE CONNECTOR STE 200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4815
Mailing Address - Country:US
Mailing Address - Phone:470-575-4321
Mailing Address - Fax:469-281-0986
Practice Address - Street 1:5555 GLENRIDGE CONNECTOR STE 200
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4815
Practice Address - Country:US
Practice Address - Phone:470-575-4321
Practice Address - Fax:469-281-0986
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA630492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1144401464OtherPRACTICE LOCATION NPI GROUP NUMBER
OH9338635OtherMEDICARE GROUP NUMBER
OH1841239274OtherMEDICARE NPI GROUP NUMBER
OH2328270Medicaid
OH2774985OtherMEDICAID GROUP NUMBER
OH9338635OtherMEDICARE GROUP NUMBER
OH2328270Medicaid
H 60392Medicare UPIN