Provider Demographics
NPI:1609286335
Name:WILLIAMS, GEORGE WELDON II (DO)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WELDON
Last Name:WILLIAMS
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 315
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:363 SOUTHCREST CIR STE 201
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-4737
Practice Address - Country:US
Practice Address - Phone:662-349-0488
Practice Address - Fax:901-850-1169
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS28428207RC0200X, 207RP1001X
TN4189207RC0200X, 207RP1001X
MO2017013013208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ064621Medicaid