Provider Demographics
NPI:1962091108
Name:WILLIAMS-WILSON, ALMONETSHA JOVELL
Entity type:Individual
Prefix:
First Name:ALMONETSHA
Middle Name:JOVELL
Last Name:WILLIAMS-WILSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 STEPHENSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5975
Mailing Address - Country:US
Mailing Address - Phone:912-355-8601
Mailing Address - Fax:
Practice Address - Street 1:712 STEPHENSON AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5975
Practice Address - Country:US
Practice Address - Phone:912-355-8601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHTC031486183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician