Healthcare Provider Details

I. General information

NPI: 1407550981
Provider Name (Legal Business Name): LAUREN WILLIAMS-BRYANT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 DALLAS HWY STE 103
VILLA RICA GA
30180-1265
US

IV. Provider business mailing address

157 CLINIC AVE STE 201
CARROLLTON GA
30117-4454
US

V. Phone/Fax

Practice location:
  • Phone: 770-214-2800
  • Fax: 770-214-2803
Mailing address:
  • Phone: 770-214-2800
  • Fax: 770-214-2803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN210993
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN210993
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: