Healthcare Provider Details

I. General information

NPI: 1982157707
Provider Name (Legal Business Name): LESLEY WILLIAMS M.D., MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH STREET BIW- 2144
AUGUSTA GA
30912
US

IV. Provider business mailing address

2549 WALTON WAY APT E2
AUGUSTA GA
30904-4579
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-4544
  • Fax:
Mailing address:
  • Phone: 678-770-5450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.069231
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number009461
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: