Healthcare Provider Details

I. General information

NPI: 1265493779
Provider Name (Legal Business Name): ERIC WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2006
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2513 SHALLOWFORD RD BUILDING 100
MARIETTA GA
30066-6809
US

IV. Provider business mailing address

2513 SHALLOWFORD RD BUILDING 100
MARIETTA GA
30066-6809
US

V. Phone/Fax

Practice location:
  • Phone: 770-516-3500
  • Fax: 770-516-3660
Mailing address:
  • Phone: 770-516-3500
  • Fax: 770-516-3660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number052654
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: