MEDICARE: MRS. SEMONE WILLIAMS IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)		GA

General Provider Information

NPI Number	:	1154061778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SEMONE WILLIAMS IBCLC

Provider Business Mailing Address
First Line	:	523 BRIANS WAY
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30907-3214
Country	:	US
Telephone Number	:	404-579-7206
Fax Number	:

Provider Business Practice Location Address
First Line	:	523 BRIANS WAY
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30907-3214
Country	:	US
Telephone Number	:	404-579-7206
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2022
Last Update Date	:	03/31/2022

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