Basic Information
| Provider Information | |||||||||
| NPI: | 1245471879 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | REESE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | WILLIAMS | ||||||||
| OtherFirstName: | KEN | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3501 PEAKE RD | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4784769285 | ||||||||
| FaxNumber: | 4784749542 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312173838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4787657000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2009 | ||||||||
| LastUpdateDate: | 03/11/2009 | ||||||||
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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 | 207R00000X | 044381 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 044381 | GA | N | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.