Healthcare Provider Details

I. General information

NPI: 1033736384
Provider Name (Legal Business Name): JEREMY JAY WILLIAMS RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 PEACHTREE ST NE # NA
ATLANTA GA
30309-2410
US

IV. Provider business mailing address

1745 PEACHTREE ST NE STE U
ATLANTA GA
30309-2479
US

V. Phone/Fax

Practice location:
  • Phone: 800-611-1811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number9946
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: