Provider Demographics
NPI:1205994985
Name:WILLIAMS-GREEN, CYNDI ANDREA (PHYSICIANASSISTANT)
Entity type:Individual
Prefix:
First Name:CYNDI
Middle Name:ANDREA
Last Name:WILLIAMS-GREEN
Suffix:
Gender:F
Credentials:PHYSICIANASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 ELLICOTT DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-3057
Mailing Address - Country:US
Mailing Address - Phone:478-971-7468
Mailing Address - Fax:478-825-5499
Practice Address - Street 1:201 AVERA DR
Practice Address - Street 2:
Practice Address - City:FORT VALLEY
Practice Address - State:GA
Practice Address - Zip Code:31030-5008
Practice Address - Country:US
Practice Address - Phone:478-825-3317
Practice Address - Fax:478-825-5499
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3051363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical