Healthcare Provider Details

I. General information

NPI: 1902144637
Provider Name (Legal Business Name): WHITNEY NICOLE WILLIAMS CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2013
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 EATONTON RD STE H2
MADISON GA
30650-5086
US

IV. Provider business mailing address

2151 EATONTON RD STE H2
MADISON GA
30650-5086
US

V. Phone/Fax

Practice location:
  • Phone: 678-583-5437
  • Fax: 833-764-0731
Mailing address:
  • Phone: 706-752-5153
  • Fax: 833-764-0731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN205403
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: