Provider Demographics
NPI:1417943374
Name:WILLIAMS, GEORGE ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ALLEN
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 1:3719 OLD ALABAMA RD
Mailing Address - Street 2:SUITE 300-G, BOX 175
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8675
Mailing Address - Country:US
Mailing Address - Phone:678-570-6822
Mailing Address - Fax:
Practice Address - Street 1:3719 OLD ALABAMA RD
Practice Address - Street 2:SUITE 300-G, BOX 175
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30022-8675
Practice Address - Country:US
Practice Address - Phone:678-570-6822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA55039208D00000X, 207V00000X
AL28403208D00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI14955Medicare UPIN