Eugennie Gloria Williams-Rose

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

10221452 Issued in GA

Practice address

4760 Austell Rd Ste 3
Austell, GA 30106-2007

Phone

(770) 726-2477

NPI assigned

Nov 8, 2022

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

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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

• Georgia Mso LLC

  • Family Medicine Physician
  • Atlanta, GA
  • NPI 1952196164
  Medicare reassignment NPD
• Livingwell Medical Clinic LLC

  • Clinic/Center
  • Austell, GA
  • NPI 1306615281
  Medicare reassignment NPD
• Pruitthealth Physicians Services, LLC

  • Internal Medicine Physician
  • Norcross, GA
  • NPI 1043676299

  Family

  Medicare reassignment NPD

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

{
    "created_epoch": "1667865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705536000000",
    "number": "1710695895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3649 LEAR CT",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301357745",
            "telephone_number": "678-448-8525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4760 AUSTELL RD STE 3",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301062007",
            "telephone_number": "770-726-2477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS-ROSE",
        "first_name": "EUGENNIE",
        "middle_name": "GLORIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-11-08",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "10221452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Geneva Wiggs, LCSW
• Wilbert Family Chiropractic
• Wilbert Family Chiropractic, LLC
• Marci Jill Wilbert, DC
• Kizzy Wilkins, APRN
• Jessica Williams, M.D.
• John Clyde Williams IV, M.D.
• Najla Shahidah Williams
• Porscha Johnson Williams
• Seana-Pierre Williams

• Family Nurse Practitioner in Austell, GA
• Providers in Austell, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.