Provider Demographics
NPI:1972098614
Name:WILLIAMS, JEFFREY RAY (DO)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:RAY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8820 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-2266
Mailing Address - Country:US
Mailing Address - Phone:770-947-3000
Mailing Address - Fax:770-947-3012
Practice Address - Street 1:8820 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2266
Practice Address - Country:US
Practice Address - Phone:770-947-3000
Practice Address - Fax:770-947-3012
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101023881207R00000X
GA93317207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine