Basic Information
| Provider Information | |||||||||
| NPI: | 1629194089 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | LASHUNDA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1058 BEAR CREEK BLVD | ||||||||
| Address2: | |||||||||
| City: | HAMPTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302281849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707070808 | ||||||||
| FaxNumber: | 7707071580 | ||||||||
| Practice Location | |||||||||
| Address1: | 1058 BEAR CREEK BLVD | ||||||||
| Address2: | |||||||||
| City: | HAMPTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707070808 | ||||||||
| FaxNumber: | 7707071580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 02/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 76992 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.