Provider Demographics
NPI:1538533906
Name:WILLIAMS, CAROLYN S (AGNP-C)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 9TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-8151
Mailing Address - Country:US
Mailing Address - Phone:409-727-2808
Mailing Address - Fax:409-727-5933
Practice Address - Street 1:2940 THE TRAIL RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-7500
Practice Address - Country:US
Practice Address - Phone:409-626-4133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-22
Last Update Date:2025-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130155363LA2200X
GA327559363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130155OtherTEXAS AP
GA327559OtherGEORGIA RN/NP