Healthcare Provider Details

I. General information

NPI: 1124346226
Provider Name (Legal Business Name): TAKEYLA NICOLE WILLIAMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 SAINT SEBASTIAN WAY STE 104
AUGUSTA GA
30901-2652
US

IV. Provider business mailing address

1949 GUNBARREL RD STE 206
CHATTANOOGA TN
37421-7133
US

V. Phone/Fax

Practice location:
  • Phone: 706-434-0130
  • Fax:
Mailing address:
  • Phone: 423-495-4349
  • Fax: 423-495-4934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number59979
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number84136
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number59979
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: