Provider Demographics
NPI:1598897530
Name:WHITE-WILLIAMS, DOROTHY A O (MD)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:A O
Last Name:WHITE-WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 MARKET ST STE C
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30021-2652
Mailing Address - Country:US
Mailing Address - Phone:404-298-9333
Mailing Address - Fax:404-298-9931
Practice Address - Street 1:3700 MARKET ST STE C
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:GA
Practice Address - Zip Code:30021-2652
Practice Address - Country:US
Practice Address - Phone:404-298-9333
Practice Address - Fax:404-298-9931
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046281207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00910093AMedicaid
GA046281OtherSTATE MEDICAL LICENSE
H48013Medicare UPIN
GA046281OtherSTATE MEDICAL LICENSE