Healthcare Provider Details

I. General information

NPI: 1174226708
Provider Name (Legal Business Name): LAVAR S. WILLIAMS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

677 CHURCH ST NE
MARIETTA GA
30060-1101
US

IV. Provider business mailing address

1140 SPRING ST NW
ATLANTA GA
30309-3140
US

V. Phone/Fax

Practice location:
  • Phone: 678-481-7063
  • Fax:
Mailing address:
  • Phone: 678-481-9114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number103966
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number103966
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: