Provider Demographics
NPI:1548723703
Name:WILLIAMS, TASHIBA (CEO)
Entity type:Individual
Prefix:MRS
First Name:TASHIBA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:TASHIBA
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:369 EMMA DR
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-4084
Mailing Address - Country:US
Mailing Address - Phone:706-254-6570
Mailing Address - Fax:800-206-0047
Practice Address - Street 1:369 EMMA DR
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-4084
Practice Address - Country:US
Practice Address - Phone:706-254-6570
Practice Address - Fax:800-206-0047
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA172A00000X, 347E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
No172A00000XOther Service ProvidersDriver