Healthcare Provider Details

I. General information

NPI: 1740587641
Provider Name (Legal Business Name): PHYSICIAN DISABILITY EXAMINATION SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2011
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 W 3RD AVE STE 8A
ALBANY GA
31701-1945
US

IV. Provider business mailing address

6600 SUGARLOAF PKWY SUITE 400 #290
DULUTH GA
30097-4452
US

V. Phone/Fax

Practice location:
  • Phone: 888-589-9064
  • Fax:
Mailing address:
  • Phone: 888-589-9064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberOS10135
License Number StateFL

VIII. Authorized Official

Name: DR. STANFORD ANTHONY WILLIAMSON
Title or Position: CEO/OWNER
Credential: DO
Phone: 888-589-9064