Healthcare Provider Details

I. General information

NPI: 1194198051
Provider Name (Legal Business Name): ANDREA WILLIAMSON-ENGLISH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2015
Last Update Date: 11/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 GREEN ST NW STUDENT SERVICES BUILDING
GAINESVILLE GA
30501-3374
US

IV. Provider business mailing address

711 GREEN ST NW
GAINESVILLE GA
30501-3374
US

V. Phone/Fax

Practice location:
  • Phone: 770-967-5846
  • Fax: 770-967-5850
Mailing address:
  • Phone: 770-967-5846
  • Fax: 770-967-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN177897
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: