1477827731 NPI number — DR. NICOLE KHALILAH WILLIAMS DC

Table of content: DR. NICOLE KHALILAH WILLIAMS DC (NPI 1477827731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477827731 NPI number — DR. NICOLE KHALILAH WILLIAMS DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
NICOLE
Provider Middle Name:
KHALILAH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KAMAU
Provider Other First Name:
NICOLE
Provider Other Middle Name:
KHALILAH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477827731
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/13/2013
NPI Reactivation Date:
02/10/2014

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4920 ROSWELL RD STE 39
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30342-2636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-963-1913
Provider Business Mailing Address Fax Number:
404-963-1947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4920 ROSWELL RD STE 39
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30342-2636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-963-1913
Provider Business Practice Location Address Fax Number:
404-963-1947
Provider Enumeration Date:
03/05/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CHIR008939 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)