=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013563055
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIEMAE WILLIAMS-CALLAWAY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/15/2019
-----------------------------------------------------
Last Update Date | 08/15/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 VIRGINIA PL
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30214-3161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-234-6652
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 VIRGINIA PL
-----------------------------------------------------
City | FAYETTEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30214-3161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-234-6652
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374T00000X
-----------------------------------------------------
Taxonomy Name | Religious Nonmedical Nursing Personnel
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------