Provider Demographics
NPI:1356461248
Name:WILLIAMS, MITZI JOI (MD)
Entity Type:Individual
Prefix:DR
First Name:MITZI
Middle Name:JOI
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 VETERANS MEMORIAL HWY SE STE 134-341
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-2945
Mailing Address - Country:US
Mailing Address - Phone:404-383-0845
Mailing Address - Fax:678-939-1451
Practice Address - Street 1:767 CONCORD RD SE STE B
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-2625
Practice Address - Country:US
Practice Address - Phone:404-383-0845
Practice Address - Fax:404-383-0906
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0004922084N0400X
GA606322084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA429169668BMedicaid
GA2021I33877Medicare PIN
GA202I139288Medicare PIN
GA212I132051Medicare PIN
GA429169668BMedicaid