Provider Demographics
NPI:1710036652
Name:WILLIAMS, MONICA JR (MD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:JR
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4424 HUGH HOWELL RD STE D
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4905
Mailing Address - Country:US
Mailing Address - Phone:404-692-4466
Mailing Address - Fax:844-572-7080
Practice Address - Street 1:4424 HUGH HOWELL RD STE D
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4905
Practice Address - Country:US
Practice Address - Phone:404-692-4466
Practice Address - Fax:844-572-7080
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8908207Q00000X
LA205424207Q00000X
GA82134207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02021591Medicaid
GA82134OtherGA MD LICENSE
LA2307053Medicaid
GA82134OtherMD LICENSE
TX175931802Medicaid
LA2307053Medicaid
LA8F1664Medicare PIN