Healthcare Provider Details

I. General information

NPI: 1043298003
Provider Name (Legal Business Name): GEORGE NORMAN WILLIAMS III CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DR SE
ATLANTA GA
30303-3050
US

IV. Provider business mailing address

7315 RAND DR
DOUGLASVILLE GA
30135-5605
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-5519
  • Fax:
Mailing address:
  • Phone: 210-722-5983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN162229
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN162229
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: