=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467395996
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAKEISHA MICHELE NICHOLSON-WILLIAMS CNA, CMA, CMT, NLP P
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2026
-----------------------------------------------------
Last Update Date | 04/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 199 HOLTON LANE LOT 2
-----------------------------------------------------
City | THOMASVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31792
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-726-6832
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 199 HOLTON LANE LOT 2
-----------------------------------------------------
City | THOMASVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31792
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 229-726-6832
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 24067692
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 374K00000X
-----------------------------------------------------
Taxonomy Name | Religious Nonmedical Practitioner
-----------------------------------------------------
License Number | 26-03838
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number | CN0000103896
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------