Provider Demographics
NPI:1154769487
Name:WILLIAMS, STEPHANE A (RN)
Entity type:Individual
Prefix:MS
First Name:STEPHANE
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 SHANK HILL RDG
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-2165
Mailing Address - Country:US
Mailing Address - Phone:706-888-8782
Mailing Address - Fax:
Practice Address - Street 1:220 SHANK HILL RDG
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2165
Practice Address - Country:US
Practice Address - Phone:706-888-8782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-09
Last Update Date:2013-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN226843163W00000X, 163WC1500X, 163WC1600X, 163WP2201X, 163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery