Provider Demographics
NPI:1306894209
Name:WILLIAMS, MARILYN (WHNP)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:RUTLEDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30663-2308
Mailing Address - Country:US
Mailing Address - Phone:770-655-5827
Mailing Address - Fax:
Practice Address - Street 1:3050 REGENT BLVD STE 400
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-5808
Practice Address - Country:US
Practice Address - Phone:214-688-8093
Practice Address - Fax:866-522-6596
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN097616363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000741804DMedicaid
GARN097616NPOtherNURSING LICENSE