MEDICARE: MRS. KRISTA WILLIAMS MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1003109497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTA WILLIAMS MA

Provider Business Mailing Address
First Line	:	1196 ROPER RD
Second Line	:
City	:	CANON
State	:	GA
Zip	:	30520-2142
Country	:	US
Telephone Number	:	678-758-2923
Fax Number	:

Provider Business Practice Location Address
First Line	:	1196 ROPER RD
Second Line	:
City	:	CANON
State	:	GA
Zip	:	30520-2142
Country	:	US
Telephone Number	:	678-758-2923
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2011
Last Update Date	:	05/18/2011

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