Healthcare Provider Details

I. General information

NPI: 1013002674
Provider Name (Legal Business Name): JAMIE A WILLIAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 REYNOLDS STREET
HARTWELL GA
30643
US

IV. Provider business mailing address

479 KNOX ROAD
MARTIN GA
30557
US

V. Phone/Fax

Practice location:
  • Phone: 706-356-5932
  • Fax:
Mailing address:
  • Phone: 706-356-5932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN144923
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: