Provider Demographics
NPI:1497407555
Name:WILLIAMS, DESTINEE
Entity Type:Individual
Prefix:MISS
First Name:DESTINEE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1752 PENNY LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-3552
Mailing Address - Country:US
Mailing Address - Phone:678-292-8346
Mailing Address - Fax:
Practice Address - Street 1:1655 MANSELL RD STE 154
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-4901
Practice Address - Country:US
Practice Address - Phone:678-292-8346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist