Healthcare Provider Details

I. General information

NPI: 1346481884
Provider Name (Legal Business Name): CANDICE J WILLIAMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CANDICE J BEREAL MD

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 LAFAYETTE PKWY STE 100
LAGRANGE GA
30241-3507
US

IV. Provider business mailing address

1075 LAFAYETTE PKWY STE 100
LAGRANGE GA
30241-3507
US

V. Phone/Fax

Practice location:
  • Phone: 706-443-5273
  • Fax: 706-530-2244
Mailing address:
  • Phone: 706-443-5273
  • Fax: 706-530-2244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number87909
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number89709
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: