Provider Demographics
NPI:1588691612
Name:WILLIAMS, WAYNE (MD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 HIGHWAY 314 STE E
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7832
Mailing Address - Country:US
Mailing Address - Phone:770-964-0611
Mailing Address - Fax:770-964-0608
Practice Address - Street 1:284 HIGHWAY 314 STE E
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7832
Practice Address - Country:US
Practice Address - Phone:770-964-0611
Practice Address - Fax:770-964-0608
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA25070207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA196692OtherBLUE CROSS
GA000272379YMedicaid
AL009989195OtherALABAMA MEDICAID
P00202509OtherRAILROAD MEDICARE
GA000272379TMedicaid
P00202509OtherRAILROAD MEDICARE
GAD33261Medicare UPIN