Provider Demographics
NPI:1891723714
Name:WILLIAMS, ANTONIO ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:ALEXANDER
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANTONIO
Other - Middle Name:ALEXANDER
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6002 PROFESSIONAL PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-5627
Mailing Address - Country:US
Mailing Address - Phone:770-968-6464
Mailing Address - Fax:470-986-7031
Practice Address - Street 1:6002 PROFESSIONAL PKWY STE 220
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5627
Practice Address - Country:US
Practice Address - Phone:770-968-6464
Practice Address - Fax:470-986-7031
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA379885251AMedicaid
GA379885251AMedicaid