Provider Demographics
NPI:1043940612
Name:WILLIAMS, MAYA (NP)
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MAYA
Other - Middle Name:L
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN, FNP-C
Mailing Address - Street 1:2107 N DECATUR RD STE 742
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5305
Mailing Address - Country:US
Mailing Address - Phone:205-605-9405
Mailing Address - Fax:
Practice Address - Street 1:71 HOWARD ST SE UNIT 1101
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-2304
Practice Address - Country:US
Practice Address - Phone:404-453-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF09191925363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily