MEDICARE: MISS KAYLA 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	2255A2300X	Athletic Trainer	AT002699	GA

General Provider Information

NPI Number	:	1528410651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KAYLA WILLIAMS

Provider Business Mailing Address
First Line	:	1001 JOHNSON FERRY RD
Second Line	:	MOB SUITE 300
City	:	ATLANTA
State	:	GA
Zip	:	30342-1605
Country	:	US
Telephone Number	:	678-416-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 SHILOH RD NW
Second Line	:	APT 914
City	:	KENNESAW
State	:	GA
Zip	:	30144-6507
Country	:	US
Telephone Number	:	678-416-7000
Fax Number	:

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

Provider Enumeration Date	:	07/13/2016
Last Update Date	:	07/13/2016

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