Healthcare Provider Details

I. General information

NPI: 1083551279
Provider Name (Legal Business Name): TABAITHA DAWN WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11045 COLUMBIA ST
BLAKELY GA
39823-3447
US

IV. Provider business mailing address

11045 COLUMBIA ST
BLAKELY GA
39823-3447
US

V. Phone/Fax

Practice location:
  • Phone: 229-723-4313
  • Fax: 229-723-3734
Mailing address:
  • Phone: 229-723-4313
  • Fax: 229-723-3734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP156102
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: