Provider Demographics
NPI:1558770123
Name:WILLIAMS, TERRY A
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1433
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-1433
Mailing Address - Country:US
Mailing Address - Phone:470-239-8860
Mailing Address - Fax:866-830-3721
Practice Address - Street 1:2400 OLD MILTON PARKWAY
Practice Address - Street 2:#1433
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009
Practice Address - Country:US
Practice Address - Phone:404-729-7644
Practice Address - Fax:866-830-3721
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
153142246ZC0007X, 246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical