Provider Demographics
NPI:1508851205
Name:WILLIAMS, CHANDRA RHODES (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHANDRA
Middle Name:RHODES
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S BELAIR RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-9110
Mailing Address - Country:US
Mailing Address - Phone:706-210-1519
Mailing Address - Fax:706-210-8081
Practice Address - Street 1:111 S BELAIR RD
Practice Address - Street 2:SUITE B
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-9110
Practice Address - Country:US
Practice Address - Phone:706-210-1519
Practice Address - Fax:706-210-8081
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011890122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
976458OtherUNITED CONCORDIA
GA00793636AMedicaid