Provider Demographics
NPI:1831638006
Name:WILLIAMS, MYA L (APRN)
Entity Type:Individual
Prefix:
First Name:MYA
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 CHARLES HARDY PKWY
Mailing Address - Street 2:STE 223
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-9470
Mailing Address - Country:US
Mailing Address - Phone:678-324-7021
Mailing Address - Fax:
Practice Address - Street 1:2713 CHARLES HARDY PKWY
Practice Address - Street 2:STE 223
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-9470
Practice Address - Country:US
Practice Address - Phone:678-324-7021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN189763363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health