Provider Demographics
NPI:1184193724
Name:WILLIAMS, SHIAN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SHIAN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 361265
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30036-1265
Mailing Address - Country:US
Mailing Address - Phone:404-491-9306
Mailing Address - Fax:
Practice Address - Street 1:4153 FLAT SHOALS PKWY BLDG C
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-4106
Practice Address - Country:US
Practice Address - Phone:404-244-9477
Practice Address - Fax:855-204-3767
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP010709235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPCET002776OtherSTATE LICENSE