Provider Demographics
NPI:1336778893
Name:WILLIAMS RURAL SURGICAL & MEDICAL CLINIC
Entity Type:Organization
Organization Name:WILLIAMS RURAL SURGICAL & MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-245-4179
Mailing Address - Street 1:PO BOX 648
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30475-0648
Mailing Address - Country:US
Mailing Address - Phone:912-245-4179
Mailing Address - Fax:912-403-3346
Practice Address - Street 1:1604 MEADOWS LN
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-8914
Practice Address - Country:US
Practice Address - Phone:912-245-4179
Practice Address - Fax:912-403-3346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center