Provider Demographics
NPI:1407402910
Name:WILLIAMS, AUGUSTA
Entity Type:Individual
Prefix:
First Name:AUGUSTA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 THORNCLIFF WAY STE 108
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-2644
Mailing Address - Country:US
Mailing Address - Phone:678-887-5083
Mailing Address - Fax:
Practice Address - Street 1:ATTN: AUGUSTA WILLIAMS
Practice Address - Street 2:2131 KINGSTON COURT SUITE 108
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8929
Practice Address - Country:US
Practice Address - Phone:678-772-7415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC002939363LP0808X
GARN198395363LP0808X
NC5012108363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health