Provider Demographics
NPI:1417907973
Name:WILLIAMS, JOHN GRADY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GRADY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 ERIN OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2866
Mailing Address - Country:US
Mailing Address - Phone:478-272-5933
Mailing Address - Fax:478-272-4350
Practice Address - Street 1:18 ERIN OFFICE PARK
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2866
Practice Address - Country:US
Practice Address - Phone:478-272-5933
Practice Address - Fax:478-272-4350
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93334207W00000X
GA057860207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA416563800BMedicaid
GAP00380152OtherRAILROAD MEDICARE
GA416563800AMedicaid
GA18BDGNVMedicare PIN
GAP00380152OtherRAILROAD MEDICARE
GA416563800BMedicaid
GA416563800AMedicaid