Healthcare Provider Details

I. General information

NPI: 1346481884
Provider Name (Legal Business Name): CANDICE J WILLIAMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CANDICE J BEREAL MD

II. Dates (important events)

Enumeration Date: 03/12/2009
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 EAGLES LANDING PKWY STE 204
STOCKBRIDGE GA
30281-7366
US

IV. Provider business mailing address

455 PHILIP BLVD STE 140
LAWRENCEVILLE GA
30046-8768
US

V. Phone/Fax

Practice location:
  • Phone: 770-962-3642
  • Fax:
Mailing address:
  • Phone: 770-962-3642
  • Fax: 770-962-3643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number87909
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number89709
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: