Provider Demographics
NPI:1538438254
Name:WILLIAMS, CHENELL DENISE
Entity type:Individual
Prefix:
First Name:CHENELL
Middle Name:DENISE
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 1:308 WILBURN ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-3637
Mailing Address - Country:US
Mailing Address - Phone:678-519-2707
Mailing Address - Fax:678-519-2707
Practice Address - Street 1:308 WILBURN ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-3637
Practice Address - Country:US
Practice Address - Phone:678-519-2707
Practice Address - Fax:678-519-2707
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-26
Last Update Date:2011-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program