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General NPI Number Information
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NPI Number | 1841436714
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Entity Type | Organization
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Legal Business Name | R. MOODY WILLIAMS DDS PC
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Dates
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Enumeration Date | 12/26/2008
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Last Update Date | 12/26/2008
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Provider Practice Location Address
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Address Line | 3580 PIEDMONT RD NE # 222
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City | ATLANTA
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State | GA
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Zip | 30305-1506
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Country | US
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Telephone | 404-233-1155
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Fax | 404-237-3337
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Provider Business Mailing Address
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Address Line | 3580 PIEDMONT RD NE # 222
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City | ATLANTA
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State | GA
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Zip | 30305-1506
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Country | US
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Telephone | 404-233-1155
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Fax | 404-237-3337
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Authorized Official
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Title or Position | PRESIDENT / ORTHODONTIST
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Name | DR. ROBERT MOODY WILLIAMS JR.
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Credential | DDS CERT. IN ORTHO
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Telephone | 404-233-1155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN010097
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License Number State | GA
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