Provider Demographics
NPI:1689719809
Name:WILLIAMS, DAVID GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GEORGE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 CINNAMINSON AVE
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:NJ
Mailing Address - Zip Code:08065
Mailing Address - Country:US
Mailing Address - Phone:856-786-8181
Mailing Address - Fax:856-786-1915
Practice Address - Street 1:430 CINNAMINSON AVE
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:NJ
Practice Address - Zip Code:08065
Practice Address - Country:US
Practice Address - Phone:856-786-8181
Practice Address - Fax:856-786-1915
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03341500208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ00082007OtherKEYSTONE
NJ3122808Medicaid
NJ0077462002OtherAMERIHEALTH
NJ0077462002OtherAMERIHEALTH
NJ082007Medicare ID - Type Unspecified