Jade Nicole Willis, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

6079 Issued in GA

Practice address

3950 Austell Rd # 22
Austell, GA 30106-1121

Phone

(770) 732-4022

NPI assigned

Sep 2, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1314921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572998400000",
    "number": "1669753745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 PARKBROOKE DR",
            "address_2": "SUITE 100",
            "city": "WOODSTOCK",
            "state": "GA",
            "postal_code": "301896331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 AUSTELL RD # 22",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061121",
            "telephone_number": "770-732-4022"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Parkbrooke Dr",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Woodstock",
            "state": "GA",
            "postal_code": "301896331",
            "country_code": "US",
            "telephone_number": "770-218-9002",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "JADE",
        "middle_name": "NICOLE",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-02",
        "last_updated": "2019-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "6079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jwillis28495@directwellstar.org",
            "affiliation": "N",
            "address_1": "3950 Austell Rd # 22",
            "city": "Austell",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301061121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jessica Williams, M.D.
• John Clyde Williams IV, M.D.
• Najla Shahidah Williams
• Porscha Johnson Williams
• Seana-Pierre Williams
• Christy Pearl Wilson, PA
• Danice Wilson, PRACTITIONER, MED
• Heather Christine Wilson, RN
• Joli Ann Wilson, D.O.
• Joseph Brannon Wilson, PA-C

• Physician Assistant in Austell, GA
• Providers in Austell, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2019; 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.