Provider Demographics
NPI:1851992978
Name:KENDRICK WILLIAMS, TEQUAWNA
Entity Type:Individual
Prefix:
First Name:TEQUAWNA
Middle Name:
Last Name:KENDRICK 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 1:146 SURGE STONE LN
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-4314
Mailing Address - Country:US
Mailing Address - Phone:678-894-6426
Mailing Address - Fax:
Practice Address - Street 1:5600 N HENRY BLVD
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-3246
Practice Address - Country:US
Practice Address - Phone:770-389-4905
Practice Address - Fax:770-389-4738
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024192183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist