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
StateLicense IDTaxonomies
MNARRT 0536792471C1101X, 2471C3402X, 2471V0106X, 2471C1106X
NCCCI 00040350246XC2901X, 246W00000X
UTCBRPA 03GA1071 RPA363AM0700X
MT2278P1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278P1006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary Function Technologist
No2471C1101XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistCardiovascular-Interventional Technology
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
No2471V0106XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular-Interventional Technology
No2471C1106XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistCardiac-Interventional Technology
No246XC2901XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularCardiovascular Invasive Specialist
No246W00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Cardiology
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical