MEDICARE: JAINEA WILLIAMS

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	222Q00000X	Developmental Therapist
2	106S00000X	Behavior Technician	RBT-25-417202	GA

General Provider Information

NPI Number	:	1154759629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAINEA WILLIAMS

Provider Business Mailing Address
First Line	:	6595 ROSWELL RD STE G5332
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-3152
Country	:	US
Telephone Number	:	678-435-9412
Fax Number	:

Provider Business Practice Location Address
First Line	:	6595 ROSWELL RD STE G5332
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-3152
Country	:	US
Telephone Number	:	678-435-9412
Fax Number	:

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

Provider Enumeration Date	:	10/21/2013
Last Update Date	:	05/14/2025

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Directions to “ JAINEA WILLIAMS ” Practice Location

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