Provider Demographics
NPI:1982173167
Name:WILLIAMS, MARIAH GAIL (PA-C)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:GAIL
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 117337
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-7337
Mailing Address - Country:US
Mailing Address - Phone:770-801-2500
Mailing Address - Fax:470-271-2895
Practice Address - Street 1:7830 VETERANS PKWY STE H
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-4973
Practice Address - Country:US
Practice Address - Phone:706-320-8881
Practice Address - Fax:706-221-3623
Is Sole Proprietor?:No
Enumeration Date:2018-11-17
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA9051363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant