Basic Information
Provider Information
NPI: 1558393405
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WILLIAMS
FirstName: GEORGE
MiddleName: ARTHUR
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 39650 ORCHARD HILL PL
Address2: 200
City: NOVI
State: MI
PostalCode: 483755391
CountryCode: US
TelephoneNumber: 2483190161
FaxNumber: 2483190170
Practice Location
Address1: 3555 W 13 MILE RD
Address2: LL-20
City: ROYAL OAK
State: MI
PostalCode: 480736710
CountryCode: US
TelephoneNumber: 2482882280
FaxNumber: 2482885644
Other Information
ProviderEnumerationDate: 07/07/2006
LastUpdateDate: 01/26/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/26/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207W00000X4301053716MIN Allopathic & Osteopathic PhysiciansOphthalmology 
207WX0107X4301053716MIY    

No ID Information.


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