Provider Demographics
NPI:1356323778
Name:WILLIAMS, JAMES EDWIN JR (DPM)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWIN
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 E FREEWAY DR SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-5965
Mailing Address - Country:US
Mailing Address - Phone:770-929-3338
Mailing Address - Fax:
Practice Address - Street 1:1025 E FREEWAY DR SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5965
Practice Address - Country:US
Practice Address - Phone:770-929-3338
Practice Address - Fax:770-760-7942
Is Sole Proprietor?:No
Enumeration Date:2005-11-20
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000489213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00253921BMedicaid
GAT98100Medicare UPIN
GA0986730001Medicare NSC