Basic Information
| Provider Information | |||||||||
| NPI: | 1528377595 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | BILLY | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.PH. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 407 WEST 4TH STREET | ||||||||
| Address2: | |||||||||
| City: | DONALSONVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 39845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2295242079 | ||||||||
| FaxNumber: | 2295242631 | ||||||||
| Practice Location | |||||||||
| Address1: | 409 WEST 3RD ST | ||||||||
| Address2: | |||||||||
| City: | DONALSONVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 39845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2295242596 | ||||||||
| FaxNumber: | 2295242631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2010 | ||||||||
| LastUpdateDate: | 09/24/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 014001 | GA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.