Provider Demographics
NPI:1457034886
Name:WILLIAMS, KENDRA
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 FERNRIDGE DR APT B
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-1968
Mailing Address - Country:US
Mailing Address - Phone:229-886-2715
Mailing Address - Fax:
Practice Address - Street 1:3215 FERNRIDGE DR APT B
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31721-1968
Practice Address - Country:US
Practice Address - Phone:229-886-2715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2025-03-06
Deactivation Date:2023-08-11
Deactivation Code:
Reactivation Date:2025-03-06
Provider Licenses
StateLicense IDTaxonomies
GA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health