Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | 87-3238268 | GA |
NPI | 1669136388 |
---|---|
Provider Name | Amanda D Williams |
First Address | Marietta, GA 30066-1200 |
Second Address | Marietta, GA 30066-1200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2021 |
Last Update Date | 28/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
87-3238268 | (05) | GA |