Healthcare Provider Details

I. General information

NPI: 1760212419
Provider Name (Legal Business Name): KIMBERLY LASHON WILLIAMS APRN, MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 JAMAR TRL
QUITMAN GA
31643-5832
US

IV. Provider business mailing address

457 JAMAR TRL
QUITMAN GA
31643-5832
US

V. Phone/Fax

Practice location:
  • Phone: 229-560-7915
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN244752
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: