MEDICARE: ILLYANA KARISHA 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	106S00000X	Behavior Technician	RBT-26-543163	GA

General Provider Information

NPI Number	:	1477486694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILLYANA KARISHA WILLIAMS

Provider Business Mailing Address
First Line	:	159 PALMER ST
Second Line	:
City	:	CAMILLA
State	:	GA
Zip	:	31730-1256
Country	:	US
Telephone Number	:	229-583-2717
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 13TH ST STE D
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-2246
Country	:	US
Telephone Number	:	706-780-1704
Fax Number	:

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

Provider Enumeration Date	:	06/06/2026
Last Update Date	:	06/06/2026

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