Provider Demographics
NPI:1144273517
Name:WILLIAMS, GEORGE ANDREW (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:ANDREW
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5709 W LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-5115
Mailing Address - Country:US
Mailing Address - Phone:469-913-8940
Mailing Address - Fax:214-366-0752
Practice Address - Street 1:5709 W LOVERS LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75209-5115
Practice Address - Country:US
Practice Address - Phone:469-913-8940
Practice Address - Fax:214-366-0752
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI061819207PE0004X
WAMD60187949207PE0004X, 207PP0204X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIGW061819OtherBLUE CROSS BLUE SHIELD
MI4136867Medicaid
MI4163800Medicaid
MIG53947Medicare UPIN
MIM60650140Medicare PIN