Organization
CARL F WILLIAMS III
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PAT DOMINEY (BUSINESS MANAGER)
(478) 472-2525
Entity
Organization
Contact information
Practice address
297 MEDICAL CT, OGLETHORPE, GA 31068-0931
(478) 472-2325
(478) 472-2325
Mailing address
297 MEDICAL CT., OGLETHORPE, GA 31068-0931
(478) 472-2325
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9788
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
168051
DORAL DENTAL SERVICES
GA
01
—
39572
AVESIS
GA
Enumeration date
03/19/2008
Last updated
04/20/2008
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