Provider Demographics
NPI:1013957208
Name:WILLIAMS, MICHAEL ROYCE (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROYCE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13269
Mailing Address - Street 2:
Mailing Address - City:EAST DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31027-2800
Mailing Address - Country:US
Mailing Address - Phone:478-274-8876
Mailing Address - Fax:478-272-9890
Practice Address - Street 1:203 CENTRAL DR
Practice Address - Street 2:
Practice Address - City:EAST DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31027-7407
Practice Address - Country:US
Practice Address - Phone:478-274-8876
Practice Address - Fax:478-272-9890
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2025-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA17327183500000X
GAPHRE87073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPHRE008707OtherGEORGIA STATE BOARD OF PHARMACY
GA457538874AMedicaid