MEDICARE: WAYNE WILLIAMS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	25070	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00202509	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	196692	OTHER	GA	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588691612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAYNE WILLIAMS MD

Provider Business Mailing Address
First Line	:	284 HIGHWAY 314 STE E
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-7832
Country	:	US
Telephone Number	:	770-964-0611
Fax Number	:	770-964-0608

Provider Business Practice Location Address
First Line	:	284 HIGHWAY 314 STE E
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-7832
Country	:	US
Telephone Number	:	770-964-0611
Fax Number	:	770-964-0608

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	08/19/2024

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Directions to “ WAYNE WILLIAMS MD” Practice Location

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