Provider Demographics
NPI:1417723248
Name:WILLIAMS, CHARMAINE (PHLEBOTOMY TECH)
Entity Type:Individual
Prefix:MRS
First Name:CHARMAINE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHLEBOTOMY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 MOLLY WAY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-8372
Mailing Address - Country:US
Mailing Address - Phone:678-914-8943
Mailing Address - Fax:
Practice Address - Street 1:1860 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-9117
Practice Address - Country:US
Practice Address - Phone:470-738-3488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAK5M6F7F5246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy