MEDICARE: AUGUSTA WILLIAMS

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AC002939	MD
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN198395	GA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5012108	NC

General Provider Information

NPI Number	:	1407402910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUGUSTA WILLIAMS

Provider Business Mailing Address
First Line	:	174 THORNCLIFF WAY STE 108
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30101-2644
Country	:	US
Telephone Number	:	678-887-5083
Fax Number	:

Provider Business Practice Location Address
First Line	:	ATTN: AUGUSTA WILLIAMS
Second Line	:	2131 KINGSTON COURT SUITE 108
City	:	MARIETTA
State	:	GA
Zip	:	30067-8929
Country	:	US
Telephone Number	:	678-772-7415
Fax Number	:

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

Provider Enumeration Date	:	08/12/2019
Last Update Date	:	04/02/2024

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