Provider Demographics
NPI:1780247353
Name:WILLIAMS, ROSCHEL (MD)
Entity type:Individual
Prefix:
First Name:ROSCHEL
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4626
Mailing Address - Country:US
Mailing Address - Phone:845-802-7600
Mailing Address - Fax:845-338-0307
Practice Address - Street 1:1910 HIGHWAY 20 SE STE 270
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2082
Practice Address - Country:US
Practice Address - Phone:770-922-3522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY319235207Q00000X
GA98391207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine