Provider Demographics
NPI:1710270343
Name:WILLIAMS MEDICAL, INC.
Entity Type:Organization
Organization Name:WILLIAMS MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:770-692-2797
Mailing Address - Street 1:101 DEVANT ST
Mailing Address - Street 2:SUITE 903
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-2710
Mailing Address - Country:US
Mailing Address - Phone:770-692-2797
Mailing Address - Fax:770-692-2791
Practice Address - Street 1:101 DEVANT ST
Practice Address - Street 2:SUITE 903
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-2710
Practice Address - Country:US
Practice Address - Phone:770-692-2797
Practice Address - Fax:770-692-2791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA125883261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care