Healthcare Provider Details

I. General information

NPI: 1982045944
Provider Name (Legal Business Name): NATHANIEL ANTWAN WILLIAMS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5885 GLENRIDGE DR
SANDY SPRINGS GA
30328-5512
US

IV. Provider business mailing address

5585 GLENRIDGE DR STE 160
SANDY SPRINGS GA
30342-1335
US

V. Phone/Fax

Practice location:
  • Phone: 470-470-3980
  • Fax: 470-470-3544
Mailing address:
  • Phone: 470-470-3980
  • Fax: 470-470-3544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number100932
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD009931
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN015175
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number33706
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number100932
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number33706
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN015175
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: