MEDICARE: DR. DAVID RUSSEL WILLIAMS MD

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	2084P0800X	Psychiatry Physician	68341	GA

General Provider Information

NPI Number	:	1689995821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID RUSSEL WILLIAMS MD

Provider Business Mailing Address
First Line	:	1499 WALTON WAY
Second Line	:	SUITE 1400
City	:	AUGUSTA
State	:	GA
Zip	:	30901-2602
Country	:	US
Telephone Number	:	706-721-6715
Fax Number	:

Provider Business Practice Location Address
First Line	:	1499 WALTON WAY
Second Line	:	SUITE 1400
City	:	AUGUSTA
State	:	GA
Zip	:	30901-2603
Country	:	US
Telephone Number	:	706-724-6100
Fax Number	:

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

Provider Enumeration Date	:	06/22/2010
Last Update Date	:	09/30/2015

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