Provider Demographics
NPI:1356686687
Name:WILLIAMS, ALEXIS RENE
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:RENE
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 1:2603 PACES RDG APT F
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-4036
Mailing Address - Country:US
Mailing Address - Phone:470-723-6410
Mailing Address - Fax:
Practice Address - Street 1:2470 WINDY HILL RD SE STE 433
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8626
Practice Address - Country:US
Practice Address - Phone:470-552-2410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACO1080061744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management