Healthcare Provider Details

I. General information

NPI: 1962895946
Provider Name (Legal Business Name): COURTNEI WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2015
Last Update Date: 03/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4267 CHAMBLEE TUCKER RD
TUCKER GA
30084
US

IV. Provider business mailing address

4267 CHAMBLEE TUCKER RD
TUCKER GA
30084
US

V. Phone/Fax

Practice location:
  • Phone: 678-744-6296
  • Fax:
Mailing address:
  • Phone: 678-744-6296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: