Healthcare Provider Details

I. General information

NPI: 1871818526
Provider Name (Legal Business Name): TINA WILLIAMS FNP-BC, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 04/17/2023
Certification Date: 12/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 WINN WAY STE 221
DECATUR GA
30030-1723
US

IV. Provider business mailing address

465 WINN WAY STE 221
DECATUR GA
30030-1723
US

V. Phone/Fax

Practice location:
  • Phone: 404-292-3810
  • Fax:
Mailing address:
  • Phone: 404-474-8491
  • Fax: 404-298-3848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN192734
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN192734
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN192734
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: