Provider Demographics
NPI:1215934419
Name:WILLIAMS, GEORGE S (CRNA)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10030 E DIAMOND DR
Mailing Address - Street 2:
Mailing Address - City:SUN LAKES
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-6121
Mailing Address - Country:US
Mailing Address - Phone:480-510-5797
Mailing Address - Fax:
Practice Address - Street 1:10030 E DIAMOND DR
Practice Address - Street 2:
Practice Address - City:SUN LAKES
Practice Address - State:AZ
Practice Address - Zip Code:85248-6121
Practice Address - Country:US
Practice Address - Phone:480-510-5797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2012-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN068889367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ69924Medicare ID - Type Unspecified
AZR38462Medicare UPIN