Provider Demographics
NPI:1598059388
Name:WILLIAMS, GARY (ATP)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 BRITTNEY LN
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-5724
Mailing Address - Country:US
Mailing Address - Phone:864-373-3530
Mailing Address - Fax:864-752-0962
Practice Address - Street 1:208 BRITTNEY LN
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-5724
Practice Address - Country:US
Practice Address - Phone:864-373-3530
Practice Address - Fax:864-752-0962
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies