Healthcare Provider Details

I. General information

NPI: 1275462434
Provider Name (Legal Business Name): PROMISE WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 13TH ST
COLUMBUS GA
31901-2248
US

IV. Provider business mailing address

2941 PEYTON DR
COLUMBUS GA
31903-2635
US

V. Phone/Fax

Practice location:
  • Phone: 170-688-7503
  • Fax:
Mailing address:
  • Phone: 706-530-6317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: