Provider Demographics
NPI:1669033403
Name:WILLIAMS, TANESHA (DMD)
Entity Type:Individual
Prefix:DR
First Name:TANESHA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3375 MORAVIA DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-2639
Mailing Address - Country:US
Mailing Address - Phone:770-987-5644
Mailing Address - Fax:
Practice Address - Street 1:1447 N EXPRESSWAY STE A
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-1752
Practice Address - Country:US
Practice Address - Phone:470-204-2409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0158891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice