Provider Demographics
NPI:1457607624
Name:D. CHARLES WILLIAMS, PH.D. P.C.
Entity type:Organization
Organization Name:D. CHARLES WILLIAMS, PH.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:D.
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:WILLIAMS, PH.D.
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:706-543-5552
Mailing Address - Street 1:1751 S LUMPKIN ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-4740
Mailing Address - Country:US
Mailing Address - Phone:706-543-5552
Mailing Address - Fax:706-354-8904
Practice Address - Street 1:1751 S LUMPKIN ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-4740
Practice Address - Country:US
Practice Address - Phone:706-543-5552
Practice Address - Fax:706-354-8904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001152103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBCGFMedicare PIN