Healthcare Provider Details

I. General information

NPI: 1730557729
Provider Name (Legal Business Name): POPULATIONS AND INTERVENTIONS TEAM COMPANY (PITC)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2015
Last Update Date: 12/08/2019
Certification Date: 12/08/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3182 BERTHAS OVERLOOK
DOUGLASVILLE GA
30135-8458
US

IV. Provider business mailing address

3182 BERTHAS OVERLOOK
DOUGLASVILLE GA
30135-8458
US

V. Phone/Fax

Practice location:
  • Phone: 678-310-9707
  • Fax:
Mailing address:
  • Phone: 678-310-9707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number4222854
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. MERCEDES MERRITT WILLIAMS
Title or Position: CEO/OWNER
Credential: DBH, MPH, ABVE, CCM
Phone: 678-310-9707