Provider Demographics
NPI:1477827731
Name:WILLIAMS, NICOLE KHALILAH (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:KHALILAH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:KHALILAH
Other - Last Name:KAMAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:4920 ROSWELL RD STE 39
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2636
Mailing Address - Country:US
Mailing Address - Phone:404-963-1913
Mailing Address - Fax:404-963-1947
Practice Address - Street 1:4920 ROSWELL RD STE 39
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-2636
Practice Address - Country:US
Practice Address - Phone:404-963-1913
Practice Address - Fax:404-963-1947
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-05
Last Update Date:2019-08-20
Deactivation Date:2013-03-13
Deactivation Code:
Reactivation Date:2014-02-10
Provider Licenses
StateLicense IDTaxonomies
GACHIR008939111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor