Provider Demographics
NPI:1265302988
Name:WILLIAMS, MATRICE LATA
Entity type:Individual
Prefix:
First Name:MATRICE
Middle Name:LATA
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 1:1625 CONLEY RD APT 207
Mailing Address - Street 2:
Mailing Address - City:CONLEY
Mailing Address - State:GA
Mailing Address - Zip Code:30288-1888
Mailing Address - Country:US
Mailing Address - Phone:404-384-1132
Mailing Address - Fax:
Practice Address - Street 1:1625 CONLEY RD APT 207
Practice Address - Street 2:
Practice Address - City:CONLEY
Practice Address - State:GA
Practice Address - Zip Code:30288-1888
Practice Address - Country:US
Practice Address - Phone:404-384-1132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-07
Last Update Date:2025-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0000089644376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty