MEDICARE: JACQKENIA 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	124Q00000X	Dental Hygienist	DH044909	GA

General Provider Information

NPI Number	:	1467311837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQKENIA WILLIAMS

Provider Business Mailing Address
First Line	:	2190 VININGS NORTH LN SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-5977
Country	:	US
Telephone Number	:	352-575-8483
Fax Number	:

Provider Business Practice Location Address
First Line	:	2201 TALMADGE RD
Second Line	:
City	:	HAMPTON
State	:	GA
Zip	:	30228-1608
Country	:	US
Telephone Number	:	352-575-8483
Fax Number	:

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

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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Directions to “ JACQKENIA WILLIAMS ” Practice Location

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