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NPI Code Detail

MEDICARE: DR. KENEESHIA NICOLE WILLIAMS M.D.

MEDICARE: DR. KENEESHIA NICOLE WILLIAMS M.D.
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
12086S0102XSurgical Critical Care Physician077597GA

General Provider Information

NPI Number : 1942437363
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENEESHIA NICOLE WILLIAMS M.D.
Provider Business Mailing Address
First Line : 55 WHITCHER ST NE STE 130
Second Line :
City : MARIETTA
State : GA
Zip : 30060-1156
Country : US
Telephone Number : 770-428-0462
Fax Number :
Provider Business Practice Location Address
First Line : 55 WHITCHER ST NE STE 130
Second Line :
City : MARIETTA
State : GA
Zip : 30060-1156
Country : US
Telephone Number : 770-428-0462
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2009
Last Update Date : 07/12/2023

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