Healthcare Provider Details

I. General information

NPI: 1184588410
Provider Name (Legal Business Name): OLUMIDE A WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1438 GLYNN OAKS DR SW
MARIETTA GA
30008-6863
US

IV. Provider business mailing address

1438 GLYNN OAKS DR SW
MARIETTA GA
30008-6863
US

V. Phone/Fax

Practice location:
  • Phone: 904-432-6585
  • Fax: 770-779-9968
Mailing address:
  • Phone: 904-432-6585
  • Fax: 770-779-9968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number881592
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: