Healthcare Provider Details

I. General information

NPI: 1962572875
Provider Name (Legal Business Name): SARA L WILLIAMS FNP C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 J L WHITE DR SUITE 100
JASPER GA
30143-4893
US

IV. Provider business mailing address

220 J L WHITE DR SUITE 100
JASPER GA
30143-4893
US

V. Phone/Fax

Practice location:
  • Phone: 706-253-8001
  • Fax: 706-253-8002
Mailing address:
  • Phone: 706-636-6500
  • Fax: 706-636-6502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN189268 NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: