Healthcare Provider Details

I. General information

NPI: 1275510398
Provider Name (Legal Business Name): TASHA ELIZABETH FELTON WILLIAMS WHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 11/17/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 W PIKE ST
LAWRENCEVILLE GA
30046-7685
US

IV. Provider business mailing address

575 W PIKE ST
LAWRENCEVILLE GA
30046-7685
US

V. Phone/Fax

Practice location:
  • Phone: 770-277-0230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN199640
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number041-309418
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: