Healthcare Provider Details

I. General information

NPI: 1659577708
Provider Name (Legal Business Name): CHARLES ODY WILLIAMS RPA-RA(CBRPA), RT(R)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CHUCK WILLIAMS RPA-RA(CBRPA), RT(R)

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE # C430
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

1801 WOMACK RD
ATLANTA GA
30338-5142
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-7034
  • Fax: 404-727-3377
Mailing address:
  • Phone: 770-390-0620
  • Fax: 770-390-0620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2471C1101X
TaxonomyCardiovascular-Interventional Technology Radiologic Technologist
License NumberARRT 053679
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License NumberARRT 053679
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code2471V0106X
TaxonomyVascular-Interventional Technology Radiologic Technologist
License NumberARRT 053679
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code2471C1106X
TaxonomyCardiac-Interventional Technology Radiologic Technologist
License NumberARRT 053679
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code246XC2901X
TaxonomyCardiovascular Invasive Specialist/Technologist
License NumberCCI 00040350
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License NumberCCI 00040350
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberCBRPA 03GA1071 RPA
License Number StateUT
# 8
Primary TaxonomyY
Taxonomy Code2278P1006X
TaxonomyPulmonary Function Technologist Certified Respiratory Therapist
License Number
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: