Provider Demographics
NPI:1528185808
Name:WILLIMAS, WILLIAM BLOUNT (DMD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BLOUNT
Last Name:WILLIMAS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1751
Mailing Address - Country:US
Mailing Address - Phone:770-831-5042
Mailing Address - Fax:770-614-7911
Practice Address - Street 1:4355 SUWANEE DAM RD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6707
Practice Address - Country:US
Practice Address - Phone:770-614-7300
Practice Address - Fax:770-614-7911
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA84651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice