Provider Demographics
NPI:1922641158
Name:WILLIAMS, MIRANDA (A-GNP-C)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:A-GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 PARK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-9039
Mailing Address - Country:US
Mailing Address - Phone:334-790-7483
Mailing Address - Fax:
Practice Address - Street 1:2812 HARTFORD HWY STE 1
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-4927
Practice Address - Country:US
Practice Address - Phone:334-712-1170
Practice Address - Fax:334-460-8391
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-156414163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse