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NPI Code Detail

MEDICARE: MISS COURTNEY DANIELLE WILLIAMS BCBA

MEDICARE: MISS COURTNEY DANIELLE WILLIAMS BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-25-79659GA

General Provider Information

NPI Number : 1063282754
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS COURTNEY DANIELLE WILLIAMS BCBA
Provider Business Mailing Address
First Line : 1105 S DAVIS RD APT 1035
Second Line :
City : LAGRANGE
State : GA
Zip : 30241-3800
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5921 BEMISS RD
Second Line :
City : VALDOSTA
State : GA
Zip : 31605-7520
Country : US
Telephone Number : 352-284-6057
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2024
Last Update Date : 05/12/2026

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