Provider Demographics
NPI:1417139395
Name:WILLIAMS, STEPHANI M (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHANI
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4052 ATLANTA ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-2693
Mailing Address - Country:US
Mailing Address - Phone:770-439-0198
Mailing Address - Fax:770-439-0297
Practice Address - Street 1:4052 ATLANTA ST
Practice Address - Street 2:SUITE C
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-2693
Practice Address - Country:US
Practice Address - Phone:770-439-0198
Practice Address - Fax:770-439-0297
Is Sole Proprietor?:No
Enumeration Date:2007-12-03
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002589364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health