Provider Demographics
NPI:1245401199
Name:CARL F WILLIAMS III
Entity Type:Organization
Organization Name:CARL F WILLIAMS III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMINEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-472-2525
Mailing Address - Street 1:297 MEDICAL CT.
Mailing Address - Street 2:
Mailing Address - City:OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:31068-0931
Mailing Address - Country:US
Mailing Address - Phone:478-472-2325
Mailing Address - Fax:
Practice Address - Street 1:297 MEDICAL CT
Practice Address - Street 2:
Practice Address - City:OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:31068-0931
Practice Address - Country:US
Practice Address - Phone:478-472-2325
Practice Address - Fax:478-472-2325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA97881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA39572OtherAVESIS
GA168051OtherDORAL DENTAL SERVICES
GA168051OtherDORAL DENTAL SERVICES