Healthcare Provider Details

I. General information

NPI: 1447663679
Provider Name (Legal Business Name): MARK DAVID WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1942 ATKINSON RD STE 100
LAWRENCEVILLE GA
30043-5004
US

IV. Provider business mailing address

1942 ATKINSON RD STE 100
LAWRENCEVILLE GA
30043-5004
US

V. Phone/Fax

Practice location:
  • Phone: 678-775-0600
  • Fax: 678-377-5284
Mailing address:
  • Phone: 678-775-0600
  • Fax: 678-377-5284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number87944
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: