Healthcare Provider Details

I. General information

NPI: 1730608522
Provider Name (Legal Business Name): POPULATIONS AND INTERVENTIONS TEAM COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 07/21/2022
Certification Date:
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: 470-875-0083
Mailing address:
  • Phone: 678-310-9707
  • Fax: 470-875-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number28315
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number40044
License Number StateCA

VIII. Authorized Official

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