Healthcare Provider Details

I. General information

NPI: 1740193705
Provider Name (Legal Business Name): MS. CANDACE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 NORTHSIDE DR NW STE A7
ATLANTA GA
30318-2695
US

IV. Provider business mailing address

1700 NORTHSIDE DR NW STE A7
ATLANTA GA
30318-2695
US

V. Phone/Fax

Practice location:
  • Phone: 678-368-5972
  • Fax:
Mailing address:
  • Phone: 678-368-5972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: