Provider Demographics
NPI:1841436714
Name:R. MOODY WILLIAMS DDS PC
Entity type:Organization
Organization Name:R. MOODY WILLIAMS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MOODY
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS CERT IN ORTHO
Authorized Official - Phone:404-233-1155
Mailing Address - Street 1:3580 PIEDMONT RD NE
Mailing Address - Street 2:# 222
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1506
Mailing Address - Country:US
Mailing Address - Phone:404-233-1155
Mailing Address - Fax:404-237-3337
Practice Address - Street 1:3580 PIEDMONT RD NE
Practice Address - Street 2:# 222
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1506
Practice Address - Country:US
Practice Address - Phone:404-233-1155
Practice Address - Fax:404-237-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-26
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0100971223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty