Provider Demographics
NPI:1972736247
Name:WILLIAMS, GEORGIA A (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGIA
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 WASHINGTON ST.
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-4983
Mailing Address - Country:US
Mailing Address - Phone:847-336-0700
Mailing Address - Fax:847-336-5773
Practice Address - Street 1:2504 WASHINGTON ST.
Practice Address - Street 2:SUITE 500
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-4983
Practice Address - Country:US
Practice Address - Phone:847-336-0700
Practice Address - Fax:847-336-5773
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190228831223G0001X
WI0004421-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice