Provider Demographics
NPI:1366551384
Name:WILLIAMS, EUGENE W (DO)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:W
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 CLEVELAND AVE
Mailing Address - Street 2:SUITE 317
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3618
Mailing Address - Country:US
Mailing Address - Phone:404-466-6317
Mailing Address - Fax:404-466-7217
Practice Address - Street 1:1136 CLEVELAND AVE
Practice Address - Street 2:SUITE 317
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3618
Practice Address - Country:US
Practice Address - Phone:404-466-6317
Practice Address - Fax:404-466-7217
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054954207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H90293Medicare UPIN
08CBBBVMedicare ID - Type Unspecified