MEDICARE: YVETTE NICOLE WILLIAMS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	6880	GA

General Provider Information

NPI Number	:	1003257593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVETTE NICOLE WILLIAMS PA-C

Provider Business Mailing Address
First Line	:	209 N CUTHBERT ST
Second Line	:
City	:	COLQUITT
State	:	GA
Zip	:	39837-3518
Country	:	US
Telephone Number	:	229-758-3385
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 RE JENNINGS AVE SE
Second Line	:
City	:	ARLINGTON
State	:	GA
Zip	:	39813-8725
Country	:	US
Telephone Number	:	229-758-4251
Fax Number	:	229-758-2212

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2013
Last Update Date	:	12/20/2024

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