Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CHIR09376 | GA |
N | 111NP0017X | Pediatric Chiropractor | CHIR09376 | GA |
NPI | 1114311743 |
---|---|
Provider Name | Jessica Williams |
First Address | Decatur, GA 30035-1210 |
Second Address | Decatur, GA 30035-1210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2015 |
Last Update Date | 20/03/2015 |