Healthcare Provider Details

I. General information

NPI: 1982202115
Provider Name (Legal Business Name): LONNEKKA PRITICE WILLIAMS LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2020
Last Update Date: 10/10/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3798 CATALPA LN
ELLENWOOD GA
30294-1921
US

IV. Provider business mailing address

3798 CATALPA LN
ELLENWOOD GA
30294-1921
US

V. Phone/Fax

Practice location:
  • Phone: 404-397-8916
  • Fax:
Mailing address:
  • Phone: 404-397-8916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberLPN087540
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberLPN087540
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberLPN087540
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberPCH008638
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberPCH008638
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberPCH008638
License Number StateGA
# 7
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN087540
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberLPN087540
License Number StateGA
# 9
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberLPN087540
License Number StateGA
# 10
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPCH008638
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: