Provider Demographics
NPI:1134264633
Name:WILLIAMS, MARGARET ELLEN (PHD, RN, APRN, BC)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ELLEN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHD, RN, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10815 SHAGBARK TRL
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-2803
Mailing Address - Country:US
Mailing Address - Phone:770-992-7540
Mailing Address - Fax:770-992-7540
Practice Address - Street 1:10815 SHAGBARK TRL
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2803
Practice Address - Country:US
Practice Address - Phone:770-992-7540
Practice Address - Fax:770-992-7540
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN067260363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00915604AMedicaid
50BBFQGMedicare ID - Type Unspecified