Healthcare Provider Details

I. General information

NPI: 1689810111
Provider Name (Legal Business Name): JACKIE ELIZABETH WILLIAMS APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4780 ASHFORD DUNWOODY RD SUITE A-266
ATLANTA GA
30338-5564
US

IV. Provider business mailing address

2690 OLD SPANISH TRL
COLLEGE PARK GA
30349-4221
US

V. Phone/Fax

Practice location:
  • Phone: 404-266-9881
  • Fax:
Mailing address:
  • Phone: 404-558-3151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License NumberRN052983
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberRN052983
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: