Healthcare Provider Details

I. General information

NPI: 1235730409
Provider Name (Legal Business Name): CHERYL LYNN WILLIAMS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERYL LYNN ROBINSON

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 11/04/2020
Certification Date: 11/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

282 SOMERSET DR
DALLAS GA
30132-9761
US

IV. Provider business mailing address

282 SOMERSET DR
DALLAS GA
30132-9761
US

V. Phone/Fax

Practice location:
  • Phone: 228-313-1976
  • Fax:
Mailing address:
  • Phone: 228-313-1976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN250805
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: