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General NPI Number Information
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NPI Number | 1194681619
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Entity Type | Individual
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Provider Name | STACEY WILLIAMS
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Gender | Female
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Dates
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Enumeration Date | 12/29/2025
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 6736 MITCHELL DR
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City | COLUMBUS
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State | GA
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Zip | 31907-3759
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Country | US
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Telephone | 706-223-0918
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Fax |
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Provider Business Mailing Address
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Address Line | 464 N OAKLEY DR APT F208
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City | COLUMBUS
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State | GA
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Zip | 31906-6562
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Country | US
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Telephone | 706-223-0918
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN328078
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License Number State | GA
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