Healthcare Provider Details

I. General information

NPI: 1457034886
Provider Name (Legal Business Name): KENDRA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date: 08/11/2023
Reactivation Date: 03/06/2025

III. Provider practice location address

2709 GILLIONVILLE RD STE 3
ALBANY GA
31721-6281
US

IV. Provider business mailing address

2935 STONEWATER DR
ALBANY GA
31721-6221
US

V. Phone/Fax

Practice location:
  • Phone: 229-886-2715
  • Fax: 229-247-5664
Mailing address:
  • Phone: 229-886-2715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberPHCP012037
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: