Tyjuan Marcquell Williams, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DN013725 Issued in GA

Practice address

4045 Jimmie Dyess Pkwy
Suite 103
Augusta, GA 30909-9491

Phone

(706) 868-4200

Fax

(706) 868-4717

NPI assigned

Jun 27, 2008

Last updated

Oct 31, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Dyess Parkway Dental, LLC

  • General Practice Dentistry
  • Augusta, GA
  • NPI 1275898900
  NPD (past)

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

{
    "created_epoch": "1214524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383177600000",
    "number": "1164684403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4045 JIMMIE DYESS PKWY",
            "address_2": "SUITE 103",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309099491",
            "telephone_number": "706-868-4200",
            "fax_number": "706-868-4717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4045 JIMMIE DYESS PKWY",
            "address_2": "SUITE 103",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309099491",
            "telephone_number": "706-868-4200",
            "fax_number": "706-868-4717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "TYJUAN",
        "middle_name": "MARCQUELL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-27",
        "last_updated": "2013-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN013725",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003107901B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shawanna Lynette Williams
• Shirlene Demetra Williams, LPN
• Sylvia Roberta Williams, R.N.
• Takeyla Nicole Williams, MD
• Tonia Williams, R.N.
• Virginia Hooks Williams, PMHNP
• Vivia Latrice Williams, LPC
• Charles Kenneth Williamson, M.D.
• Daniel Lee Williamson, AGACNP-BC
• Don E Williamson, MD

• Dentist in Augusta, GA
• Providers in Augusta, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.