NPIMap

Individual provider Active NPI

David M Williams, M.D.

  • Family Medicine Physician
  • Atlanta, GA
National Provider Identifier
1023005873
Registry record updated Mar 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
029997 Issued in GA
Practice address
1046 Ridge Ave SW
Atlanta, GA 30315-1640
Phone
(404) 688-1350
Fax
(404) 564-6734
NPI assigned
Oct 5, 2005
Last updated
Mar 25, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 029997 GA Primary

Addresses

Primary practice location

1046 Ridge Ave SW
Atlanta, GA 30315-1640

Mailing address

1046 Ridge Ave SW
Atlanta, GA 30315-1640
Phone (404) 688-1350

Other identifiers 4

IdentifierTypeStateIssuer
000432726HMedicaidGA
000432726NMedicaidGA
000432726OMedicaidGA
000432726MMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120606000618 GA Practitioner - Family Practice 0749185825 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Southside Medical Center, Inc. CurrentSince Apr 14, 2012 Accepting new patients
Southside Medical Center, Inc CurrentSince Jul 2, 1990 Accepting new patients
Suncrest Home Health-Southside, LLC Current Accepting new patients

Locations

1039 Ridge Ave SW
Atlanta, GA 30315
Phone (407) 761-8640

1046 Ridge Ave SW
Atlanta, GA 30315
Phone (404) 564-6942

Interoperability endpoints

  • Direct secure messaging: david.williams.p1@direct.smcmed.nextgenshare.com

Ownership & related parties

All facility ownership & control disclosures 16

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Suncrest Home HealthAtlanta, GA, CCN 117022 Home health agency Corporate Director
W-2 Managing Employee		 Mar 1, 2021
Mar 1, 2021
Southside Medical Center, Inc.Atlanta, GA, CCN 111877 Federally qualified health center Corporate Director
W-2 Managing Employee		 Jul 2, 1990
Jul 2, 1990
Southside Medical Center, Inc.Atlanta, GA, CCN 111879 Federally qualified health center Corporate Director
W-2 Managing Employee		 Jul 2, 1990
Jul 2, 1990
Southside Medical Center, Inc.Forest Park, GA, CCN 111880 Federally qualified health center Corporate Director
W-2 Managing Employee		 Jul 2, 1990
May 6, 2004
Southside Medical Center, Inc.Riverdale, GA, CCN 111891 Federally qualified health center Corporate Director
W-2 Managing Employee		 Aug 15, 1997
Aug 15, 1997
Southside Medical Center, Inc.Atlanta, GA, CCN 111881 Federally qualified health center Corporate Director
W-2 Managing Employee		 Jul 2, 1990
Jul 2, 1990
Southside Medical Center, Inc.Norcross, GA, CCN 111867 Federally qualified health center Corporate Director
W-2 Managing Employee		 Jul 2, 1990
Jul 2, 1990
SMC - Jackson ClinicHampton, GA, CCN 111890 Federally qualified health center Corporate Director
W-2 Managing Employee		 Jul 2, 1990
Mar 12, 2013
Southside Medical Center- Jackson ClinicJackson, GA, CCN 111983 Federally qualified health center Corporate Director
W-2 Managing Employee		 May 5, 2014
May 5, 2014
SMC - Spalding CountyGriffin, GA, CCN 111018 Federally qualified health center W-2 Managing Employee Jul 2, 1990
Southside Medical Center at Dobbs ElementaryAtlanta, GA, CCN 111061 Federally qualified health center Corporate Officer
W-2 Managing Employee (100%)		 Jul 2, 1990
Jul 2, 1990
Southside Medical Center, Inc.Atlanta, GA, CCN 851063 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Jul 2, 1990
Jul 2, 1990
Southside Medical Center, Inc.Lawrenceville, GA, CCN 111808 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Jul 2, 1990
Jul 2, 1990
Southside Medical Center, Inc.Stockbridge, GA, CCN C21029 Federally qualified health center Corporate Director
W-2 Managing Employee		 Jul 2, 1990
Jul 2, 1990
Southside Medical Center School Based Health Center at Huie ElementaryForest Park, GA, CCN C21047 Federally qualified health center Corporate Director
W-2 Managing Employee		 Jul 2, 1990
Jul 2, 1990
Southside Medical Center School Based Health Center at Lee ElementaryJonesboro, GA, CCN C21049 Federally qualified health center Corporate Director
W-2 Managing Employee		 Jul 2, 1990
Jul 2, 1990

Owned or controlled facilities with NPI records 16

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 16

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1128470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237939200000",
    "number": "1023005873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1046 RIDGE AVE SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303151640",
            "telephone_number": "404-688-1350",
            "fax_number": "404-564-6734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1046 RIDGE AVE SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303151640",
            "telephone_number": "404-688-1350",
            "fax_number": "404-564-6734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "DAVID",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-05",
        "last_updated": "2009-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "029997",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000432726H",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000432726N",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000432726O",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000432726M",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

Verify at the official NPI Registry.