Healthcare Provider Details

I. General information

NPI: 1215576434
Provider Name (Legal Business Name): ALEXIS WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 CARLTON DR E
PALMETTO GA
30268-1098
US

IV. Provider business mailing address

523 CARLTON DR E
PALMETTO GA
30268-1098
US

V. Phone/Fax

Practice location:
  • Phone: 678-208-3959
  • Fax:
Mailing address:
  • Phone: 678-208-3959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: