=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427531433
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TRENETHA MICHELLE WILLIAMS PT, DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2018
-----------------------------------------------------
Last Update Date | 04/30/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 LOWER FAYETTEVILLE RD STE 2000
-----------------------------------------------------
City | NEWNAN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30265-6506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-251-7284
-----------------------------------------------------
Fax | 770-251-7295
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 352 FLINT ST
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36604-1912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-377-9229
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PTH9038
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT013783
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------