Provider Demographics
NPI:1689810111
Name:WILLIAMS, JACKIE ELIZABETH (APRN-BC)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:ELIZABETH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2690 OLD SPANISH TRL
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-4221
Mailing Address - Country:US
Mailing Address - Phone:404-558-3151
Mailing Address - Fax:
Practice Address - Street 1:4780 ASHFORD DUNWOODY RD
Practice Address - Street 2:SUITE A-266
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-5564
Practice Address - Country:US
Practice Address - Phone:404-266-9881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN052983364SG0600X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology