Provider Demographics
NPI:1255492187
Name:WILLIAMS, TARA LYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:LYN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:1125 BRIARCLIFF PL NE
Mailing Address - Street 2:APARTMENT 10
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-3908
Mailing Address - Country:US
Mailing Address - Phone:410-905-1092
Mailing Address - Fax:
Practice Address - Street 1:1640 POWERS FERRY RD SE BLDG 9
Practice Address - Street 2:SUITE 100
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5491
Practice Address - Country:US
Practice Address - Phone:770-953-0080
Practice Address - Fax:770-953-0031
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAPSY003067103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical