MEDICARE: STEPHANI M WILLIAMS PA-C

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	364SF0001X	Family Health Clinical Nurse Specialist	002589	GA

General Provider Information

NPI Number	:	1417139395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANI M WILLIAMS PA-C

Provider Business Mailing Address
First Line	:	4052 ATLANTA ST
Second Line	:	SUITE C
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-2693
Country	:	US
Telephone Number	:	770-439-0198
Fax Number	:	770-439-0297

Provider Business Practice Location Address
First Line	:	4052 ATLANTA ST
Second Line	:	SUITE C
City	:	POWDER SPRINGS
State	:	GA
Zip	:	30127-2693
Country	:	US
Telephone Number	:	770-439-0198
Fax Number	:	770-439-0297

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

Provider Enumeration Date	:	12/03/2007
Last Update Date	:	12/06/2007

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