Healthcare Provider Details

I. General information

NPI: 1467370379
Provider Name (Legal Business Name): EBONY WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5517 WELLBORN CREEK DR
LITHONIA GA
30058-3553
US

IV. Provider business mailing address

5517 WELLBORN CREEK DR
LITHONIA GA
30058-3553
US

V. Phone/Fax

Practice location:
  • Phone: 678-367-5214
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN221826
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: