MEDICARE: WILLIEMAE WILLIAMS-CALLAWAY

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	374T00000X	Religious Nonmedical Nursing Personnel

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00000000	OTHER		N/A

General Provider Information

NPI Number	:	1013563055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIEMAE WILLIAMS-CALLAWAY

Provider Business Mailing Address
First Line	:	120 VIRGINIA PL
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-3161
Country	:	US
Telephone Number	:	404-234-6652
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 VIRGINIA PL
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-3161
Country	:	US
Telephone Number	:	404-234-6652
Fax Number	:

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

Provider Enumeration Date	:	08/15/2019
Last Update Date	:	08/15/2019

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Directions to “ WILLIEMAE WILLIAMS-CALLAWAY ” Practice Location

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