Provider Demographics
NPI:1639954811
Name:WILLIAMS, KATRENA DENISE
Entity Type:Individual
Prefix:MRS
First Name:KATRENA
Middle Name:DENISE
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 1:4501 RUSSELL PKWY STE 36
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-8681
Mailing Address - Country:US
Mailing Address - Phone:719-220-0596
Mailing Address - Fax:
Practice Address - Street 1:4501 RUSSELL PKWY STE 36
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-8681
Practice Address - Country:US
Practice Address - Phone:719-220-0596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GABR0211131744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management