Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 066841 | GA |
NPI | 1336167600 |
---|---|
Provider Name | Mr. Shawn Ray Williams |
First Address | Statesboro, GA 30458-4765 |
Second Address | Statesboro, GA 30458-4765 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 12/11/2014 |