Healthcare Provider Details

I. General information

NPI: 1265501514
Provider Name (Legal Business Name): STEPHEN PHILIP WILLIAMS PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 PHOENIX BLVD STE 120
COLLEGE PARK GA
30349-5062
US

IV. Provider business mailing address

1901 PHOENIX BLVD STE 120
COLLEGE PARK GA
30349-5062
US

V. Phone/Fax

Practice location:
  • Phone: 404-355-8066
  • Fax: 844-345-6042
Mailing address:
  • Phone: 404-355-8066
  • Fax: 844-345-6042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA001107
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: