Provider Demographics
NPI:1457481368
Name:WILLIAMS, JERROD LAQUINTON SR (CSA)
Entity Type:Individual
Prefix:MR
First Name:JERROD
Middle Name:LAQUINTON
Last Name:WILLIAMS
Suffix:SR
Gender:M
Credentials:CSA
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 420429
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-0429
Mailing Address - Country:US
Mailing Address - Phone:404-932-0295
Mailing Address - Fax:
Practice Address - Street 1:1341 GREENRIDGE TRL
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-2203
Practice Address - Country:US
Practice Address - Phone:404-932-0295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2610163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant