MEDICARE: EDDISON WILLIAMS

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	390200000X	Student in an Organized Health Care Education/Training Program		AR
2	207L00000X	Anesthesiology Physician	101456	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487067807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDDISON WILLIAMS

Provider Business Mailing Address
First Line	:	5671 PEACHTREE DUNWOODY RD STE 680
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-5014
Country	:	US
Telephone Number	:	423-557-2329
Fax Number	:

Provider Business Practice Location Address
First Line	:	5671 PEACHTREE DUNWOODY RD STE 680
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-5014
Country	:	US
Telephone Number	:	423-557-2329
Fax Number	:

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

Provider Enumeration Date	:	06/03/2014
Last Update Date	:	12/03/2024

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Directions to “ EDDISON WILLIAMS ” Practice Location

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