Healthcare Provider Details

I. General information

NPI: 1598756603
Provider Name (Legal Business Name): ANNA J WILLIAMS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 S LUMPKIN ST
ATHENS GA
30606-4740
US

IV. Provider business mailing address

195 WINTERSETT PL
WINTERVILLE GA
30683-2907
US

V. Phone/Fax

Practice location:
  • Phone: 706-546-6937
  • Fax: 706-354-8904
Mailing address:
  • Phone: 706-742-8894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number701
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: