Provider Demographics
NPI:1427118181
Name:WILLIAMS, GARY M (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 600
Mailing Address - Street 2:
Mailing Address - City:HAWKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31036-0600
Mailing Address - Country:US
Mailing Address - Phone:478-783-3025
Mailing Address - Fax:478-783-3028
Practice Address - Street 1:222 PERRY HWY
Practice Address - Street 2:PULASKI PROF BLDG B
Practice Address - City:HAWKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31036-6748
Practice Address - Country:US
Practice Address - Phone:478-783-3025
Practice Address - Fax:478-783-3028
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042771207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000728373BMedicaid
GA11BDMZDMedicare ID - Type Unspecified
GAE17348Medicare UPIN