Provider Demographics
NPI:1396720652
Name:WILLIAMS, LATOYA (APRN,BC)
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 VILLAGE CENTER PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9044
Mailing Address - Country:US
Mailing Address - Phone:678-289-0508
Mailing Address - Fax:770-692-0301
Practice Address - Street 1:250 VILLAGE CENTER PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9044
Practice Address - Country:US
Practice Address - Phone:678-289-0508
Practice Address - Fax:770-692-0301
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN145166363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBJFNMedicare ID - Type Unspecified
GAQ39390Medicare UPIN