Healthcare Provider Details

I. General information

NPI: 1992445480
Provider Name (Legal Business Name): KAYLA CHILDERS WILLIAMS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1489 KENNEDY RD
TIFTON GA
31794-4159
US

IV. Provider business mailing address

1489 KENNEDY RD
TIFTON GA
31794-4159
US

V. Phone/Fax

Practice location:
  • Phone: 229-238-2007
  • Fax:
Mailing address:
  • Phone: 229-238-2007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN276124
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: