Provider Demographics
NPI:1407822158
Name:WILLIAMS, JEFFREY M (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3320 OLD JEFFERSON RD
Mailing Address - Street 2:BLDG 400
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-1400
Mailing Address - Country:US
Mailing Address - Phone:706-613-1625
Mailing Address - Fax:706-613-1629
Practice Address - Street 1:3320 OLD JEFFERSON RD
Practice Address - Street 2:BLDG 400
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-1400
Practice Address - Country:US
Practice Address - Phone:706-613-1625
Practice Address - Fax:706-613-1629
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA048837207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00867963AMedicaid
G65329Medicare UPIN
GA10BDHKGMedicare PIN