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General NPI Number Information
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NPI Number | 1619042215
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Entity Type | Individual
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Provider Name | THOMAS MICHAEL WILLIAMS O.D.
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Gender | Male
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 500 E ALICE ST
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City | BAINBRIDGE
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State | GA
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Zip | 39819-4998
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Country | US
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Telephone | 229-246-9525
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Fax | 229-246-9514
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Provider Business Mailing Address
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Address Line | 19874 STATE ROAD 71 N
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City | BLOUNTSTOWN
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State | FL
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Zip | 32424-6609
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Country | US
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Telephone | 229-246-9525
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Fax | 229-246-9514
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | GA002083
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License Number State | GA
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