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General NPI Number Information
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NPI Number | 1659506046
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Entity Type | Individual
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Provider Name | JAKARA M WILLIAMS
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Gender | Female
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Dates
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Enumeration Date | 05/28/2009
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Last Update Date | 05/28/2009
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Provider Practice Location Address
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Address Line | 3000 NORTHWOODS PKWY SUITE 105
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City | NORCROSS
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State | GA
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Zip | 30071-4708
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Country | US
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Telephone | 678-993-2303
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Fax |
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Provider Business Mailing Address
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Address Line | 308 OLDUVAI BLVD
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City | TUSKEGEE
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State | AL
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Zip | 36083-3065
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Country | US
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Telephone | 334-727-9477
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Fax |
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 004270
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License Number State | GA
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