Provider Demographics
NPI:1174846216
Name:WILLIAMS, MARY LYNN (NP-C)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5610
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31010-5610
Mailing Address - Country:US
Mailing Address - Phone:229-273-8881
Mailing Address - Fax:229-273-8985
Practice Address - Street 1:602 E 16TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-1776
Practice Address - Country:US
Practice Address - Phone:229-271-9330
Practice Address - Fax:229-271-9245
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2011-12-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN102733363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily