Provider Demographics
NPI:1336748607
Name:WILLIAMS, SELENA BURNS (DOCTOR OF PHARMACY)
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:BURNS
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DOCTOR OF PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-1494
Mailing Address - Country:US
Mailing Address - Phone:478-746-5842
Mailing Address - Fax:
Practice Address - Street 1:660 NORTH AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31211-1494
Practice Address - Country:US
Practice Address - Phone:478-746-5842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021282183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist