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General NPI Number Information
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NPI Number | 1326185125
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Entity Type | Individual
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Provider Name | MARLA LAYNE WILLIAMS NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 300 W HOSPITAL RD
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City | FORT GORDON
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State | GA
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Zip | 30905-5741
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Country | US
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Telephone | 706-787-1370
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Fax | 706-787-8131
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Provider Business Mailing Address
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Address Line | 613 BURGAMY PASS
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City | GROVETOWN
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State | GA
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Zip | 30813-5856
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Country | US
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Telephone | 706-860-5944
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R124653
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License Number State | GA
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