Healthcare Provider Details

I. General information

NPI: 1346668969
Provider Name (Legal Business Name): ANDRAY MCWILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 08/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 PEACHTREE RD NE STE D145
ATLANTA GA
30319-3020
US

IV. Provider business mailing address

4060 PEACHTREE RD NE STE D145
ATLANTA GA
30319-3020
US

V. Phone/Fax

Practice location:
  • Phone: 561-449-3716
  • Fax:
Mailing address:
  • Phone: 561-449-3716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number592389561
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number592289560
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: