Provider Demographics
NPI:1518347194
Name:WILLIAMS, NANCY (FNP-C)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 TOM BREWER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-4064
Mailing Address - Country:US
Mailing Address - Phone:770-466-1789
Mailing Address - Fax:770-466-1321
Practice Address - Street 1:605 TOM BREWER RD STE 200
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-4064
Practice Address - Country:US
Practice Address - Phone:770-466-1789
Practice Address - Fax:770-466-1321
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN183651363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily