Healthcare Provider Details

I. General information

NPI: 1306894209
Provider Name (Legal Business Name): MARILYN WILLIAMS WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 REGENT BLVD STE 400
IRVING TX
75063-5808
US

IV. Provider business mailing address

2750 OLD MILL RD
RUTLEDGE GA
30663-2308
US

V. Phone/Fax

Practice location:
  • Phone: 214-688-8093
  • Fax: 866-522-6596
Mailing address:
  • Phone: 770-655-5827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN097616
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: