Provider Demographics
NPI:1962390591
Name:WILLIAMS, JUSTIN K (NP-C)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:K
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5400 BOWMAN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-8879
Mailing Address - Country:US
Mailing Address - Phone:478-745-6576
Mailing Address - Fax:478-746-0018
Practice Address - Street 1:5400 BOWMAN RD STE 100
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-8879
Practice Address - Country:US
Practice Address - Phone:478-745-6576
Practice Address - Fax:478-746-0018
Is Sole Proprietor?:No
Enumeration Date:2025-06-24
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN254892363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology