Healthcare Provider Details

I. General information

NPI: 1114050549
Provider Name (Legal Business Name): HENRY C. WILLIAMS JR. H.I.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 JOHN W MORROW JR PKWY SUITE 113
GAINESVILLE GA
30501-8531
US

IV. Provider business mailing address

250 JOHN W MORROW JR PKWY SUITE 113
GAINESVILLE GA
30501-8531
US

V. Phone/Fax

Practice location:
  • Phone: 770-532-5092
  • Fax:
Mailing address:
  • Phone: 770-532-5092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADS000413
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: