Provider Demographics
NPI: | 1659577708 |
---|---|
Name: | WILLIAMS, CHARLES ODY (RPA-RA(CBRPA), RT(R)) |
Entity Type: | Individual |
Prefix: | MR |
First Name: | CHARLES |
Middle Name: | ODY |
Last Name: | WILLIAMS |
Suffix: | |
Gender: | M |
Credentials: | RPA-RA(CBRPA), RT(R) |
Other - Prefix: | MR |
Other - First Name: | CHUCK |
Other - Middle Name: | |
Other - Last Name: | WILLIAMS |
Other - Suffix: | |
Other - Last Name Type: | Other Name |
Other - Credentials: | RPA-RA(CBRPA), RT(R) |
Mailing Address - Street 1: | 1801 WOMACK RD |
Mailing Address - Street 2: | |
Mailing Address - City: | ATLANTA |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30338-5142 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 770-390-0620 |
Mailing Address - Fax: | 770-390-0620 |
Practice Address - Street 1: | 1365 CLIFTON RD NE # C430 |
Practice Address - Street 2: | |
Practice Address - City: | ATLANTA |
Practice Address - State: | GA |
Practice Address - Zip Code: | 30322-1013 |
Practice Address - Country: | US |
Practice Address - Phone: | 404-712-7034 |
Practice Address - Fax: | 404-727-3377 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2007-06-25 |
Last Update Date: | 2007-07-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MN | ARRT 053679 | 2471C1101X, 2471C3402X, 2471V0106X, 2471C1106X |
NC | CCI 00040350 | 246XC2901X, 246W00000X |
UT | CBRPA 03GA1071 RPA | 363AM0700X |
MT | 2278P1006X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2278P1006X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified | Pulmonary Function Technologist |
No | 2471C1101X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Cardiovascular-Interventional Technology |
No | 2471C3402X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Radiography |
No | 2471V0106X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Vascular-Interventional Technology |
No | 2471C1106X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Cardiac-Interventional Technology |
No | 246XC2901X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist Cardiovascular | Cardiovascular Invasive Specialist |
No | 246W00000X | Technologists, Technicians & Other Technical Service Providers | Technician, Cardiology | |
No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |