Provider Demographics
NPI:1568687986
Name:GEORGE RAYMOND WILLIAMS, M.D.
Entity Type:Organization
Organization Name:GEORGE RAYMOND WILLIAMS, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-948-8556
Mailing Address - Street 1:1233 WAYNE GILMORE CIRCLE
Mailing Address - Street 2:SUITE 250A
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570
Mailing Address - Country:US
Mailing Address - Phone:337-948-8556
Mailing Address - Fax:337-948-6881
Practice Address - Street 1:1233 WAYNE GILMORE CIRCLE
Practice Address - Street 2:SUITE 250A
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570
Practice Address - Country:US
Practice Address - Phone:337-948-8556
Practice Address - Fax:337-948-6881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021658174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1672271Medicaid
LA437132863BOtherBCBS
LA4921640001Medicare NSC
LA1672271Medicaid
LA5CG56Medicare ID - Type Unspecified