Healthcare Provider Details

I. General information

NPI: 1881202679
Provider Name (Legal Business Name): MS. EBONE J WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 PEACHTREE CENTER AVE NE STE 600
ATLANTA GA
30303-1277
US

IV. Provider business mailing address

6991 GALLANT CIR SE
MABLETON GA
30126-4683
US

V. Phone/Fax

Practice location:
  • Phone: 866-787-6341
  • Fax:
Mailing address:
  • Phone: 404-547-3633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number590107010286585
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: