Provider Demographics
NPI:1528410651
Name:WILLIAMS, KAYLA
Entity Type:Individual
Prefix:MISS
First Name:KAYLA
Middle Name:
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 1:1001 JOHNSON FERRY RD
Mailing Address - Street 2:MOB SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1605
Mailing Address - Country:US
Mailing Address - Phone:678-416-7000
Mailing Address - Fax:
Practice Address - Street 1:1750 SHILOH RD NW
Practice Address - Street 2:APT 914
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6507
Practice Address - Country:US
Practice Address - Phone:678-416-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0026992255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer