Provider Demographics
NPI:1932822772
Name:WILLIAMS, LEE CONSTANCE (FNP-C)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:CONSTANCE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 WESTWOOD HEIGHTS COURT
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31535
Mailing Address - Country:US
Mailing Address - Phone:912-381-3556
Mailing Address - Fax:
Practice Address - Street 1:1301 PETERSON AVE S
Practice Address - Street 2:SUITE B
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533
Practice Address - Country:US
Practice Address - Phone:912-383-6966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN278035363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner