Provider Demographics
NPI:1457032997
Name:WILLIAMS, KATHY MARIA
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:MARIA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CHIMNEY ROCK RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-9318
Mailing Address - Country:US
Mailing Address - Phone:478-918-5937
Mailing Address - Fax:
Practice Address - Street 1:105 CHIMNEY ROCK RD
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-9318
Practice Address - Country:US
Practice Address - Phone:478-918-5937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN060512164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse