Provider Demographics
NPI:1871818526
Name:WILLIAMS, TINA (FNP-BC, CNM)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP-BC, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 WINN WAY STE 221
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1723
Mailing Address - Country:US
Mailing Address - Phone:404-474-8491
Mailing Address - Fax:404-298-3848
Practice Address - Street 1:465 WINN WAY STE 221
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1723
Practice Address - Country:US
Practice Address - Phone:404-292-3810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN192734363LF0000X, 363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner