Provider Demographics
NPI:1205072477
Name:WILLIAMS, SHARON (FNP-C)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 EAGLES WALK
Mailing Address - Street 2:SUITE A
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7340
Mailing Address - Country:US
Mailing Address - Phone:770-389-3855
Mailing Address - Fax:770-474-8078
Practice Address - Street 1:145 EAGLES WALK
Practice Address - Street 2:SUITE A
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7340
Practice Address - Country:US
Practice Address - Phone:770-389-3855
Practice Address - Fax:770-474-8078
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN107542363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA333398679BMedicaid
GA511I500865Medicare PIN