Provider Demographics
NPI:1871851063
Name:WILLIAMS, JUANITA
Entity type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:
Last Name:WILLIAMS
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 1:235 W ROOSEVELT AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-2640
Mailing Address - Country:US
Mailing Address - Phone:229-436-3070
Mailing Address - Fax:229-436-0406
Practice Address - Street 1:235 W ROOSEVELT AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2640
Practice Address - Country:US
Practice Address - Phone:229-436-3070
Practice Address - Fax:229-436-0406
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047-R-0034251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health