Healthcare Provider Details

I. General information

NPI: 1477705465
Provider Name (Legal Business Name): JACQUES R. WILLIAMS DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 CAMPBELLTON ST
DOUGLASVILLE GA
30134-1876
US

IV. Provider business mailing address

8415 CAMPBELLTON ST
DOUGLASVILLE GA
30134-1876
US

V. Phone/Fax

Practice location:
  • Phone: 770-942-4899
  • Fax: 770-942-4859
Mailing address:
  • Phone: 770-942-4899
  • Fax: 770-942-4859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDN013290
License Number StateGA

VIII. Authorized Official

Name: DR. JACQUES RAMONE WILLIAMS
Title or Position: PRESIDENT
Credential: DDS
Phone: 770-942-4899