=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528184314
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNETTE S WILLIAMS P.A.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2007
-----------------------------------------------------
Last Update Date | 11/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3580 ATLANTA AVE
-----------------------------------------------------
City | HAPEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30354-1706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-768-3351
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5080 SPECTRUM DR STE 1200 W
-----------------------------------------------------
City | ADDISON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75001-4648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-364-8000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 001939
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------