Provider Demographics
NPI:1487007464
Name:WILLIAMS, PAULETTE (RD)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:PAULETTE
Other - Middle Name:SCOTT
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RD
Mailing Address - Street 1:1921 AVONDALE CT
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-7414
Mailing Address - Country:US
Mailing Address - Phone:404-717-9394
Mailing Address - Fax:770-742-0931
Practice Address - Street 1:1921 AVONDALE CT
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-7414
Practice Address - Country:US
Practice Address - Phone:404-717-9394
Practice Address - Fax:770-742-0931
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD001383133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered