MEDICARE: DR. DONIELLE FA'NICE WILLIAMS DMD

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	1223P0221X	Pediatric Dentistry	DN015712	GA

General Provider Information

NPI Number	:	1780181412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONIELLE FA'NICE WILLIAMS DMD

Provider Business Mailing Address
First Line	:	3921 OBRYANT CIR SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30082-3906
Country	:	US
Telephone Number	:	404-512-1889
Fax Number	:

Provider Business Practice Location Address
First Line	:	4920 ROSWELL RD STE 265
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-2686
Country	:	US
Telephone Number	:	404-458-9908
Fax Number	:	404-458-9905

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

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	01/14/2025

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