MEDICARE: TAKEYLA NICOLE WILLIAMS MD

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	2086X0206X	Surgical Oncology Physician	59979	TN
2	208600000X	Surgery Physician	84136	GA
3	208600000X	Surgery Physician	59979	TN

General Provider Information

NPI Number	:	1124346226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAKEYLA NICOLE WILLIAMS MD

Provider Business Mailing Address
First Line	:	1949 GUNBARREL RD STE 206
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-7133
Country	:	US
Telephone Number	:	423-495-4349
Fax Number	:	423-495-4934

Provider Business Practice Location Address
First Line	:	818 SAINT SEBASTIAN WAY STE 104
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30901-2652
Country	:	US
Telephone Number	:	706-434-0130
Fax Number	:

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

Provider Enumeration Date	:	05/13/2010
Last Update Date	:	04/03/2025

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