Healthcare Provider Details

I. General information

NPI: 1508851205
Provider Name (Legal Business Name): CHANDRA RHODES WILLIAMS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S BELAIR RD SUITE B
MARTINEZ GA
30907-9110
US

IV. Provider business mailing address

111 S BELAIR RD SUITE B
MARTINEZ GA
30907-9110
US

V. Phone/Fax

Practice location:
  • Phone: 706-210-1519
  • Fax: 706-210-8081
Mailing address:
  • Phone: 706-210-1519
  • Fax: 706-210-8081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number011890
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: