Healthcare Provider Details

I. General information

NPI: 1033730130
Provider Name (Legal Business Name): HEATHER LACEY WILLIAMS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2020
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 KEVIN LN
ROCK SPRING GA
30739-2272
US

IV. Provider business mailing address

97 KEVIN LN
ROCK SPRING GA
30739-2272
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN210991
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number27256
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: