Healthcare Provider Details

I. General information

NPI: 1407140999
Provider Name (Legal Business Name): ASHLEY WILLIAMS ZIMMERMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY BETH WILLIAMS FNP

II. Dates (important events)

Enumeration Date: 06/02/2011
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 RIVER PL STE 340
BRASELTON GA
30517
US

IV. Provider business mailing address

PO BOX 742616
ATLANTA GA
30374-2616
US

V. Phone/Fax

Practice location:
  • Phone: 770-219-6520
  • Fax: 770-219-6521
Mailing address:
  • Phone: 770-219-8420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN190851
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN190851
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: