Provider Demographics
NPI:1235995614
Name:WILLIAMS, MIESHA LEIGH
Entity Type:Individual
Prefix:
First Name:MIESHA
Middle Name:LEIGH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4022 DOROTHY DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-5428
Mailing Address - Country:US
Mailing Address - Phone:478-228-4158
Mailing Address - Fax:
Practice Address - Street 1:4022 DOROTHY DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-5428
Practice Address - Country:US
Practice Address - Phone:478-228-4158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist