Provider Demographics
NPI:1376735399
Name:WILLIAMS, PAULETTE (CDE, RD, & LD)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CDE, RD, & LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 S PENDLETON ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-3047
Mailing Address - Country:US
Mailing Address - Phone:864-855-7030
Mailing Address - Fax:864-855-7019
Practice Address - Street 1:790 N MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-4275
Practice Address - Country:US
Practice Address - Phone:404-234-6570
Practice Address - Fax:706-782-1840
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA315876133V00000X
GALD000046133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA71BBBWMOtherPTAN/LEGACY