Organization
PRESTIGE ADVANCED HEALTHCARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CIERRA NICOLE WILLIAMS (NURSE PRACTITIONER)
(470) 295-9981
Entity
Organization
Contact information
Practice address
102 MAIN ST STE 204, LAGRANGE, GA 30240-3225
(706) 756-5317
(844) 740-1379
Mailing address
43 BRISBANE CT, NEWNAN, GA 30263-2370
(470) 295-9981
(844) 740-1379
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
233631
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1730557752
NURSE PRACTITIONER
GA
Enumeration date
05/08/2017
Last updated
10/18/2018
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