Healthcare Provider Details

I. General information

NPI: 1548202401
Provider Name (Legal Business Name): ROBERT JACKSON WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 05/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S WASHINGTON ST
LINCOLNTON GA
30817-2870
US

IV. Provider business mailing address

PO BOX 568
WASHINGTON GA
30673-0568
US

V. Phone/Fax

Practice location:
  • Phone: 706-359-4215
  • Fax: 706-359-1662
Mailing address:
  • Phone: 706-359-4215
  • Fax: 706-359-1662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29263
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: