Healthcare Provider Details

I. General information

NPI: 1568687986
Provider Name (Legal Business Name): GEORGE RAYMOND WILLIAMS, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 WAYNE GILMORE CIRCLE SUITE 250A
OPELOUSAS LA
70570
US

IV. Provider business mailing address

1233 WAYNE GILMORE CIRCLE SUITE 250A
OPELOUSAS LA
70570
US

V. Phone/Fax

Practice location:
  • Phone: 337-948-8556
  • Fax: 337-948-6881
Mailing address:
  • Phone: 337-948-8556
  • Fax: 337-948-6881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number021658
License Number StateLA

VIII. Authorized Official

Name: DR. GEORGE RAYMOND WILLIAMS
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 337-948-8556