Healthcare Provider Details

I. General information

NPI: 1699696401
Provider Name (Legal Business Name): MARK K WILLIAMS PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2026
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 JOHNSON FERRY RD STE 450
MARIETTA GA
30068-5433
US

IV. Provider business mailing address

3025 ANTLER TRL
MARIETTA GA
30066-4130
US

V. Phone/Fax

Practice location:
  • Phone: 770-694-6349
  • Fax:
Mailing address:
  • Phone: 731-443-3153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-NP225726
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: