Provider Demographics
NPI:1932445202
Name:WILLIAMS, ANDREW HENRY (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:HENRY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 CAMELLIA TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-2669
Mailing Address - Country:US
Mailing Address - Phone:301-399-0716
Mailing Address - Fax:
Practice Address - Street 1:2311 CASCADE RD SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-3201
Practice Address - Country:US
Practice Address - Phone:301-399-0716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002199152W00000X
MDTA2384152W00000X
GAOPT003070152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist