Healthcare Provider Details

I. General information

NPI: 1104367465
Provider Name (Legal Business Name): ANYTA HICKS-WILLIAMS AGNP-C, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2017
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 PEACHTREE ST NW STE 510
ATLANTA GA
30309-2462
US

IV. Provider business mailing address

PO BOX 1132
PENSACOLA FL
32591-1132
US

V. Phone/Fax

Practice location:
  • Phone: 850-313-4616
  • Fax: 619-329-8933
Mailing address:
  • Phone: 850-313-4616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberGAA-NP000275
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberGAA-NP000275
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11010204
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberGAA-NP000275
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN11010204
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberGAA-NP000275
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: