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General NPI Number Information
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NPI Number | 1386234953
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Entity Type | Individual
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Provider Name | MELISSA WILLIAMSON M.ED/ CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 01/19/2021
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 400 ADAMS ST UNIT B
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City | VIDALIA
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State | GA
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Zip | 30474-4817
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Country | US
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Telephone | 478-254-0636
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Fax | 912-525-2847
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Provider Business Mailing Address
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Address Line | 618 BOWENS MILL RD SW
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City | DOUGLAS
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State | GA
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Zip | 31533-3926
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Country | US
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Telephone | 912-331-0846
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Fax | 678-792-4894
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SLP011852
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License Number State | GA
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