Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | GA38402 | GA |
NPI | 1235131525 |
---|---|
Provider Name | Dennis A Williams |
First Address | Evans, GA 30809-3603 |
Second Address | Evans, GA 30809-3603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 27/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00616756B | (05) | GA |
009938356 | (05) | AL |
F77681 | (02) | GA |