=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063697951
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANKLE AND FOOT SPECIALISTS OF ROCKDALE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/09/2008
-----------------------------------------------------
Last Update Date | 01/09/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1025 E FREEWAY DR SE
-----------------------------------------------------
City | CONYERS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30094-5965
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-929-3338
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1025 E FREEWAY DR SE
-----------------------------------------------------
City | CONYERS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30094-5965
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-929-3338
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | DR. JAMES EDWIM WILLIAMS JR.
-----------------------------------------------------
Credential | D.P.M.
-----------------------------------------------------
Telephone | 770-929-3338
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213ES0103X
-----------------------------------------------------
Taxonomy Name | Foot & Ankle Surgery Podiatrist
-----------------------------------------------------
License Number | 000489
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------