Healthcare Provider Details

I. General information

NPI: 1336905835
Provider Name (Legal Business Name): KAMILLE WILLIAMS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10968 SOUTHWOOD DR
HAMPTON GA
30228-5302
US

IV. Provider business mailing address

10968 SOUTHWOOD DR
HAMPTON GA
30228-5302
US

V. Phone/Fax

Practice location:
  • Phone: 404-922-3117
  • Fax:
Mailing address:
  • Phone: 404-922-3117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2828037
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number22237348
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: