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General NPI Number Information
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NPI Number | 1023320942
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Entity Type | Organization
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Legal Business Name | EAST ATLANTA FAMILY MEDICINE
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Dates
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Enumeration Date | 07/08/2010
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Last Update Date | 07/06/2012
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Provider Practice Location Address
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Address Line | 3660 FLAT SHOALS RD SUITE 200
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City | DECATUR
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State | GA
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Zip | 30034-1632
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Country | US
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Telephone | 404-244-1813
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Fax | 404-244-1831
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Provider Business Mailing Address
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Address Line | 3660 FLAT SHOALS RD SUITE 250
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City | DECATUR
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State | GA
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Zip | 30034-1632
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Country | US
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Telephone | 404-244-1813
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Fax | 404-244-1831
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Authorized Official
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Title or Position | CEO/PHYSICIAN
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Name | EUGENE W WILLIAMS
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Credential | D.O.
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Telephone | 404-244-1813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 54954
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License Number State | GA
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