Provider Demographics
NPI:1477705465
Name:JACQUES R. WILLIAMS DDS PC
Entity Type:Organization
Organization Name:JACQUES R. WILLIAMS DDS PC
Other - Org Name:UPTOWN DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUES
Authorized Official - Middle Name:RAMONE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-942-4899
Mailing Address - Street 1:8415 CAMPBELLTON ST
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-1876
Mailing Address - Country:US
Mailing Address - Phone:770-942-4899
Mailing Address - Fax:770-942-4859
Practice Address - Street 1:8415 CAMPBELLTON ST
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-1876
Practice Address - Country:US
Practice Address - Phone:770-942-4899
Practice Address - Fax:770-942-4859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013290261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA27000355Medicaid