Provider Demographics
NPI:1487064051
Name:PHYSICIAN DISABILITY EXAMINATION SERVICES INC
Entity type:Organization
Organization Name:PHYSICIAN DISABILITY EXAMINATION SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RASHEEDA
Authorized Official - Middle Name:G
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-573-0039
Mailing Address - Street 1:6600 SUGARLOAF PKWY
Mailing Address - Street 2:SUITE 400 #290
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097
Mailing Address - Country:US
Mailing Address - Phone:229-573-0039
Mailing Address - Fax:888-684-8452
Practice Address - Street 1:507 W 3RD AVE STE 8A
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1945
Practice Address - Country:US
Practice Address - Phone:888-589-9064
Practice Address - Fax:888-684-8452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-05
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10135208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty