MEDICARE: MS. EBONY MONIQUE WILLIAMS CNA

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	374U00000X	Home Health Aide	CN0014180730	GA
2	374U00000X	Home Health Aide		GA

General Provider Information

NPI Number	:	1992085096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EBONY MONIQUE WILLIAMS CNA

Provider Business Mailing Address
First Line	:	8105 NORTH RIDGEBROOK DRIVE
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29420
Country	:	US
Telephone Number	:	404-734-6913
Fax Number	:

Provider Business Practice Location Address
First Line	:	1714 CROSSINGS DR
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-3933
Country	:	US
Telephone Number	:	404-734-6913
Fax Number	:

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

Provider Enumeration Date	:	08/19/2011
Last Update Date	:	02/18/2016

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