Provider Demographics
NPI:1891723714
Name:WILLIAMS, ANTONIO ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:ALEXANDER
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANTONIO
Other - Middle Name:ALEXANDER
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1000 CORPORATE CENTER DR 200
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-4129
Mailing Address - Country:US
Mailing Address - Phone:770-968-6464
Mailing Address - Fax:770-968-6455
Practice Address - Street 1:1000 CORPORATE CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-4180
Practice Address - Country:US
Practice Address - Phone:770-968-6464
Practice Address - Fax:770-968-6455
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA379885251AMedicaid
GA379885251AMedicaid