MEDICARE: DR. MYREON WILLIAMS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	045668	GA

General Provider Information

NPI Number	:	1467520460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MYREON WILLIAMS M.D.

Provider Business Mailing Address
First Line	:	300 W HOSPITAL ROAD
Second Line	:	EISENHOWER ARMY MEDICAL CENTER (CREDENTIALS)
City	:	FT. GORDON
State	:	GA
Zip	:	30905-5650
Country	:	US
Telephone Number	:	706-787-2720
Fax Number	:	706-787-8176

Provider Business Practice Location Address
First Line	:	300 W HOSPITAL ROAD
Second Line	:	EISENHOWER ARMY MEDICAL CENTER (CREDENTIALS)
City	:	FT. GORDON
State	:	GA
Zip	:	30905-5650
Country	:	US
Telephone Number	:	706-787-2720
Fax Number	:	706-787-8176

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	07/08/2007

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