NPIMap

Individual provider Active NPI

Mary Lynn Williams, NP-C

  • Family Nurse Practitioner
  • Cordele, GA
National Provider Identifier
1174846216
Registry record updated Dec 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN102733 Issued in GA
Practice address
602 E 16TH Ave
Suite B
Cordele, GA 31015-1776
Phone
(229) 271-9330
Fax
(229) 271-9245
NPI assigned
Mar 3, 2010
Last updated
Dec 10, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN102733 GA Primary

Addresses

Primary practice location

602 E 16TH Ave
Suite B
Cordele, GA 31015-1776

Mailing address

PO Box 5610
Cordele, GA 31010-5610
Phone (229) 273-8881

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, GA, OR3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20140509001881 TX Practitioner - Nurse Practitioner 7214163567 Reassigns benefits to 2 organizations
I20150506002892 GA Practitioner - Nurse Practitioner 7214163567 Reassigns benefits to 1 organization
I20231006003268 OR Practitioner - Nurse Practitioner 7214163567 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Vanderbilt University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

107 H St
P O Box 67
Poplar, MT 59255-0067

107 H St E
P O Box 67
Poplar, MT 59255-0067

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Medical Foundation of Tillamook CurrentSince Aug 24, 2023 Accepting new patients
DHHS PHS Naihs Chinle Comprehensive Health Care Facility CurrentSince Feb 3, 2014 Accepting new patients
DHHS PHS Naihs Chinle Comprehensive Health Care Facility Current Accepting new patients
Greater Athens Physicians, Inc CurrentSince May 1, 2015 Accepting new patients
U S Health Dept of Health & Human Services CurrentSince Apr 2, 2024 Accepting new patients
Northwest Medical Foundation of Tillamook CurrentSince Aug 24, 2023 Accepting new patients
Northwest Medical Foundation of Tillamook Current Accepting new patients
DHHS PHS Naihs Chinle Comprehensive CurrentSince Feb 3, 2014 Accepting new patients
US Health Dept of Health & Human Services CurrentSince Apr 2, 2024 Accepting new patients
Careconnect Health, Inc. Past Accepting new patients
Athens Family Medicine Past Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients

Locations

1550 Mars Hill Rd
Watkinsville, GA 30677
Phone (706) 769-4852

669 Agency Main St
Harlem, MT 59526
Phone (406) 353-3100

107 H St
Poplar, MT 59255
Phone (406) 738-3491

222 SE Jefferson St
Sheridan, OR 97378
Phone (503) 843-1535

1000 3rd St
Tillamook, OR 97141
Phone (503) 251-6129

1000 3rd St
#M
Tillamook, OR 97141
Phone (503) 815-2260

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EEEBBD

Organizations & group practices 12

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1267574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323475200000",
    "number": "1174846216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5610",
            "city": "CORDELE",
            "state": "GA",
            "postal_code": "310105610",
            "telephone_number": "229-273-8881",
            "fax_number": "229-273-8985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 E 16TH AVE",
            "address_2": "SUITE B",
            "city": "CORDELE",
            "state": "GA",
            "postal_code": "310151776",
            "telephone_number": "229-271-9330",
            "fax_number": "229-271-9245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "MARY",
        "middle_name": "LYNN",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-03",
        "last_updated": "2011-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN102733",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cordele, GA

Sources for this page

Verify at the official NPI Registry.