Healthcare Provider Details

I. General information

NPI: 1821072406
Provider Name (Legal Business Name): JOEL ALFRED WILLIAMS III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 PROFESSIONAL CT
DALTON GA
30720-2500
US

IV. Provider business mailing address

1506 PROFESSIONAL CT
DALTON GA
30720-2500
US

V. Phone/Fax

Practice location:
  • Phone: 706-278-2700
  • Fax: 706-278-3444
Mailing address:
  • Phone: 706-278-2700
  • Fax: 706-278-3444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberO46516
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: