Provider Demographics
NPI:1013881853
Name:WILLIAMS, LISA M
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ARDAWA
Other - Middle Name:N
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MANGER
Mailing Address - Street 1:236 BLACK HAWKE LN
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-1405
Mailing Address - Country:US
Mailing Address - Phone:478-832-0185
Mailing Address - Fax:
Practice Address - Street 1:236 BLACK HAWKE LN
Practice Address - Street 2:
Practice Address - City:KATHLEEN
Practice Address - State:GA
Practice Address - Zip Code:31047-1405
Practice Address - Country:US
Practice Address - Phone:478-832-0185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health