Healthcare Provider Details

I. General information

NPI: 1487572061
Provider Name (Legal Business Name): TYRA ZHANE WILLIAMS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 ASHLEY NICOLE AVE
BONAIRE GA
31005-5628
US

IV. Provider business mailing address

269 ASHLEY NICOLE AVE
BONAIRE GA
31005-5628
US

V. Phone/Fax

Practice location:
  • Phone: 478-662-0659
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP269645
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: