Provider Demographics
NPI:1689995821
Name:WILLIAMS, DAVID RUSSEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RUSSEL
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 1:1499 WALTON WAY
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2602
Mailing Address - Country:US
Mailing Address - Phone:706-721-6715
Mailing Address - Fax:
Practice Address - Street 1:1499 WALTON WAY
Practice Address - Street 2:SUITE 1400
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2603
Practice Address - Country:US
Practice Address - Phone:706-724-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-22
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA683412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry