Healthcare Provider Details

I. General information

NPI: 1235193228
Provider Name (Legal Business Name): GEORGE WELDON WILLIAMS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2006
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 W FLORIDA ST
DEMING NM
88030-4908
US

IV. Provider business mailing address

122 S GOLD AVE STE 3
DEMING NM
88030-3755
US

V. Phone/Fax

Practice location:
  • Phone: 505-546-4811
  • Fax: 505-546-4821
Mailing address:
  • Phone: 575-545-7280
  • Fax: 575-544-7281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA92590
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: