Provider Demographics
NPI:1861968760
Name:WILLIAMS, SHAWNTAVIA POWE
Entity type:Individual
Prefix:
First Name:SHAWNTAVIA
Middle Name:POWE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAWNTAVIA
Other - Middle Name:LATRICE
Other - Last Name:POWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 19TH STREET NORTH SUITE 321
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35203-1801
Mailing Address - Country:US
Mailing Address - Phone:205-498-5519
Mailing Address - Fax:855-710-8104
Practice Address - Street 1:324 COMMONS DR STE 21
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6962
Practice Address - Country:US
Practice Address - Phone:205-498-5519
Practice Address - Fax:855-710-8104
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNP500014926363LF0000X
FLTPAN1615363LF0000X
AL1-143824363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily