Provider Demographics
NPI:1841725819
Name:WILLIAMS, KEYANNA (DMS, PA-C)
Entity type:Individual
Prefix:DR
First Name:KEYANNA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DMS, PA-C
Other - Prefix:
Other - First Name:KEYANNA
Other - Middle Name:
Other - Last Name:WEBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 142412
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-6514
Mailing Address - Country:US
Mailing Address - Phone:678-545-8102
Mailing Address - Fax:
Practice Address - Street 1:1373 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30344-3423
Practice Address - Country:US
Practice Address - Phone:678-573-2970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8267363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant