Healthcare Provider Details

I. General information

NPI: 1497120414
Provider Name (Legal Business Name): TUMESHA LASHAY WILLIAMS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1279 HIGHWAY 54 W STE 100
FAYETTEVILLE GA
30214-4551
US

IV. Provider business mailing address

1046 RIDGE AVE SW
ATLANTA GA
30315-1640
US

V. Phone/Fax

Practice location:
  • Phone: 770-719-5710
  • Fax:
Mailing address:
  • Phone: 404-688-1350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN205755
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN205755
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: