Provider Demographics
NPI:1801225719
Name:WILLIAMS, NATISHA SHONTRELL (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:NATISHA
Middle Name:SHONTRELL
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 LIBERTY GROVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:WRIGHTSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31096-4446
Mailing Address - Country:US
Mailing Address - Phone:478-595-0746
Mailing Address - Fax:
Practice Address - Street 1:4921 LIBERTY GROVE CHURCH RD
Practice Address - Street 2:
Practice Address - City:WRIGHTSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31096-4446
Practice Address - Country:US
Practice Address - Phone:478-595-0746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN305054363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA582109771OtherTAX ID
GA300030912AMedicaid
GA300030912AMedicaid