Provider Demographics
NPI:1235200866
Name:WILLIAMS, AMY J (MPT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:J
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MPT
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 17805
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-0805
Mailing Address - Country:US
Mailing Address - Phone:404-428-8071
Mailing Address - Fax:678-623-0214
Practice Address - Street 1:416 HOOPER ST SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30317-3417
Practice Address - Country:US
Practice Address - Phone:404-428-8071
Practice Address - Fax:678-623-0214
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006817225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000869811-BMedicaid