Provider Demographics
NPI:1386777332
Name:WILLIAMS, AGNES (LPN)
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 DAYS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT GAINES
Mailing Address - State:GA
Mailing Address - Zip Code:39851-2237
Mailing Address - Country:US
Mailing Address - Phone:229-768-3096
Mailing Address - Fax:
Practice Address - Street 1:201 VILLA NOVA ST
Practice Address - Street 2:
Practice Address - City:CUTHBERT
Practice Address - State:GA
Practice Address - Zip Code:39840-1037
Practice Address - Country:US
Practice Address - Phone:229-732-5276
Practice Address - Fax:229-732-5090
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN036477101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health