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NPI Code Detail

MEDICARE: DR. KEYANNA WILLIAMS DMS, PA-C

MEDICARE: DR. KEYANNA WILLIAMS DMS, 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
1363A00000XPhysician Assistant8267GA

General Provider Information

NPI Number : 1841725819
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEYANNA WILLIAMS DMS, PA-C
Provider Business Mailing Address
First Line : PO BOX 142412
Second Line :
City : FAYETTEVILLE
State : GA
Zip : 30214-6514
Country : US
Telephone Number : 678-545-8102
Fax Number :
Provider Business Practice Location Address
First Line : 1373 CLEVELAND AVE
Second Line :
City : ATLANTA
State : GA
Zip : 30344-3423
Country : US
Telephone Number : 678-573-2970
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2017
Last Update Date : 12/27/2019

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