Provider Demographics
NPI:1184725814
Name:WILLIAMS, ALFRED AUGUST (MD)
Entity type:Individual
Prefix:
First Name:ALFRED
Middle Name:AUGUST
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 PHILIP BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8733
Mailing Address - Country:US
Mailing Address - Phone:770-339-0039
Mailing Address - Fax:770-339-7605
Practice Address - Street 1:355 PHILIP BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8733
Practice Address - Country:US
Practice Address - Phone:770-339-0039
Practice Address - Fax:770-339-7605
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA32116174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000403455BMedicaid
GA000403455BMedicaid
GAF11130Medicare UPIN