MEDICARE: BRANDI MICHELLE WILLIAMS LCSW

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1013516608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI MICHELLE WILLIAMS LCSW

Provider Business Mailing Address
First Line	:	4255 WADE GREEN RD NW STE 414
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30144-1763
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1808 OVER LAKE DR SE STE D
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-6608
Country	:	US
Telephone Number	:	678-213-2194
Fax Number	:

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

Provider Enumeration Date	:	10/23/2020
Last Update Date	:	10/23/2020

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