Ikeyshana Willis

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Practice address

17213 Sugarloaf Reserve Dr
Duluth, GA 30097-5209

Phone

(470) 800-2040

NPI assigned

Mar 10, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1615334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615334400000",
    "number": "1003491283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17213 SUGARLOAF RESERVE DR",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300975209",
            "telephone_number": "470-800-2040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17213 SUGARLOAF RESERVE DR",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300975209",
            "telephone_number": "470-800-2040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "IKEYSHANA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-10",
        "last_updated": "2021-03-10",
        "certification_date": "2021-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Latravia Lishell Williams, CNA
• Sharyon Williams, FNP-C
• Shelby Englishe Williams, RN
• Barbara Williamson
• Janet Williamson
• Jessie Nelson Willis, CCC-SLP
• Wilmington Medical Supply, Inc.
• Ashley Airelle Wilson, PA-C
• Barbara Mitchell Wilson, CRNFA
• Benjamin Wilson, PT, DPT

• Health Service Clinic/Center in Duluth, GA
• Providers in Duluth, GA by specialty
• Health Service Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.