Healthcare Provider Details

I. General information

NPI: 1093339319
Provider Name (Legal Business Name): YOLANDA RENAE WILLIAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 WOODMONT LN NW STE 4497
ATLANTA GA
30318-2866
US

IV. Provider business mailing address

1445 WOODMONT LN NW STE 4497
ATLANTA GA
30318-2866
US

V. Phone/Fax

Practice location:
  • Phone: 229-364-2375
  • Fax:
Mailing address:
  • Phone: 229-364-2375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN227911
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN227911
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: