Provider Demographics
NPI:1154081107
Name:WILLIAMS, DESHAWN (APRN)
Entity Type:Individual
Prefix:
First Name:DESHAWN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN
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 6298
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30722-6298
Mailing Address - Country:US
Mailing Address - Phone:706-271-0100
Mailing Address - Fax:706-270-0487
Practice Address - Street 1:4028 HIGHWAY 5
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-3530
Practice Address - Country:US
Practice Address - Phone:770-942-7111
Practice Address - Fax:678-715-9951
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN273282363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner