Mironda Williams, M.D.
Individual provider Active NPI Obstetrics & Gynecology Physician · Peachtree City, GA
NPI 1780773085 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1780773085
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- License
- 033755 (GA)
- Practice address
- 210 Clover Reach
Peachtree City, GA 30269-1657 - Phone
- (770) 487-9604
- Fax
- (770) 631-0540
- NPI assigned
- Oct 12, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 2
Owned or controlled facilities with NPI records 1
Medicare Care Compare profile
- Specialty
- Obstetrics/Gynecology
- Education
- Medical College of Georgia School of Medicine, 1988
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Peachtree City Obstetrics and Gynecology, P.C.
Practice addresses (Care Compare)
210 Clover Reach
Peachtree City, GA 30269-1657
Phone (770) 487-9604
775 Poplar Rd
Suite 360
Newnan, GA 30265-8304
Phone (770) 487-9604
Hospital & facility affiliations
- Piedmont Newnan Hospital, Inc
- Piedmont Fayette Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Piedmont Fayette Hospital Inc |
Hospital | Corporate Director | Jul 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101208001030 | GA | Practitioner - Obstetrics/Gynecology | 2769679372 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 033755 | GA | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peachtree City Obstetrics and Gynecology, P.C. | Obstetrics & Gynecology | Current |
Accepting new patients |
| Peachtree City Obstetrics and Gynecology, P.C. | Obstetrics & Gynecology | Past | Accepting new patients |
Locations
775 Poplar Rd
Ste 360
Newnan, GA 30265
Phone (770) 487-9604
210 Clover Reach
Peachtree Cty, GA 30269
Phone (770) 487-9604
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 033755 | GA | Yes |
Addresses
Primary practice location
210 Clover Reach
Peachtree City, GA 30269-1657
Mailing address
210 Clover Reach
P. O. Box 2505
Peachtree City, GA 30269-1657
Phone (770) 487-9604
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00494909G | Medicaid | GA |
Other providers in Peachtree City, GA
- Chantelle Williams
- Harold Jackson Williams Jr.
- Jan D. Williams
- Kristina Elaine Williams
- Kyle Edward Williams
- Paige Williams
- Lindsey Willis
- Mark Willis II
- Willow Heart Home Care LLC
- Anne Wilson
All providers in Peachtree City, GA · Obstetrics & Gynecology Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.