Provider Demographics
NPI:1801576343
Name:WILLIAMS, LATRICE (FNP-C, FNP-BC)
Entity type:Individual
Prefix:
First Name:LATRICE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP-C, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 GEORGE BUSBEE PKWY NW APT 514
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6829
Mailing Address - Country:US
Mailing Address - Phone:229-412-4898
Mailing Address - Fax:
Practice Address - Street 1:3755 SIXES RD STE 203
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-7847
Practice Address - Country:US
Practice Address - Phone:678-880-6698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN220055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily