Provider Demographics
NPI:1740587641
Name:PHYSICIAN DISABILITY EXAMINATION SERVICES INC
Entity Type:Organization
Organization Name:PHYSICIAN DISABILITY EXAMINATION SERVICES INC
Other - Org Name:DANIA BEACH WEST MEDICINE AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANFORD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:888-589-9064
Mailing Address - Street 1:6600 SUGARLOAF PKWY
Mailing Address - Street 2:SUITE 400 #290
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4452
Mailing Address - Country:US
Mailing Address - Phone:888-589-9064
Mailing Address - Fax:
Practice Address - Street 1:507 W 3RD AVE STE 8A
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1945
Practice Address - Country:US
Practice Address - Phone:888-589-9064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-12
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP3300X
FLOS10135261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000-106-500Medicaid
FLFE094AMedicare Oscar/Certification