Provider Demographics
NPI:1578164190
Name:WILLIAMS, GIANNA
Entity Type:Individual
Prefix:
First Name:GIANNA
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 1:3114 PALM CT
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-3129
Mailing Address - Country:US
Mailing Address - Phone:706-306-1013
Mailing Address - Fax:
Practice Address - Street 1:270 BOBBY JONES EXPY STE 158
Practice Address - Street 2:STUDIO 23
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-3086
Practice Address - Country:US
Practice Address - Phone:706-306-1013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACO107721174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty