Provider Demographics
NPI:1477092856
Name:WILLIAMS, JACQUELINE LAVINIA (NP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:LAVINIA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3300 HOLCOMB BRIDGE RD
Mailing Address - Street 2:SUTIE 110
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-5404
Mailing Address - Country:US
Mailing Address - Phone:770-449-5161
Mailing Address - Fax:
Practice Address - Street 1:3300 HOLCOMB BRIDGE RD
Practice Address - Street 2:SUTIE 110
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-5404
Practice Address - Country:US
Practice Address - Phone:770-449-5161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-17
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN261557363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily