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NPI Code Detail

MEDICARE: LISA WILLIAMS M ED CCC/SLP

MEDICARE: LISA WILLIAMS M ED CCC/SLP
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
1235Z00000XSpeech-Language PathologistSLP008831GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558738062
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA WILLIAMS M ED CCC/SLP
Provider Business Mailing Address
First Line : 118 PEARL AVE N
Second Line :
City : DOUGLAS
State : GA
Zip : 31533-4632
Country : US
Telephone Number : 912-331-0846
Fax Number : 678-792-4894
Provider Business Practice Location Address
First Line : 618 BOWENS MILL RD SW
Second Line :
City : DOUGLAS
State : GA
Zip : 31533-3926
Country : US
Telephone Number : 912-331-0846
Fax Number : 678-792-4894
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2015
Last Update Date : 03/02/2021

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Directions to “ LISA WILLIAMS M ED CCC/SLP” Practice Location

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