MEDICARE: JENNIFER E WILLIAMS PT, DPT

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
1	174400000X	Specialist	PT011019	GA

General Provider Information

NPI Number	:	1063859932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER E WILLIAMS PT, DPT

Provider Business Mailing Address
First Line	:	5005 LANIER ISLANDS PKWY
Second Line	:	SUITE 300
City	:	BUFORD
State	:	GA
Zip	:	30518-1801
Country	:	US
Telephone Number	:	770-271-3458
Fax Number	:	770-271-8036

Provider Business Practice Location Address
First Line	:	4875 HOG MOUNTAIN RD
Second Line	:	SUITE A
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-3476
Country	:	US
Telephone Number	:	770-967-9301
Fax Number	:	770-967-9526

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2013
Last Update Date	:	05/31/2013

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