Healthcare Provider Details

I. General information

NPI: 1851311534
Provider Name (Legal Business Name): THOMAS CHENEY WILLIAMS D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 N JEFF DAVIS DR SUITE #1
FAYETTEVILLE GA
30214-1625
US

IV. Provider business mailing address

265 N JEFF DAVIS DR SUITE #1
FAYETTEVILLE GA
30214-1625
US

V. Phone/Fax

Practice location:
  • Phone: 678-817-5900
  • Fax: 678-817-1775
Mailing address:
  • Phone: 678-817-5900
  • Fax: 678-817-1775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8464
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8464
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: