MEDICARE: MRS. CHANEL WILLIAMS FNP-C

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	363LF0000X	Family Nurse Practitioner	RN255542	GA

General Provider Information

NPI Number	:	1952933004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHANEL WILLIAMS FNP-C

Provider Business Mailing Address
First Line	:	100 PIEDMONT RD NE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-3636
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 PIEDMONT RD NE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-3636
Country	:	US
Telephone Number	:	770-795-9844
Fax Number	:

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

Provider Enumeration Date	:	02/06/2020
Last Update Date	:	02/08/2020

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