Provider Demographics
NPI:1568139376
Name:WILLIAMS, BRANDY LYNN (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S MEADOWS RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GRANTVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30220-1945
Mailing Address - Country:US
Mailing Address - Phone:912-245-0348
Mailing Address - Fax:
Practice Address - Street 1:130 S MEADOWS RIDGE DR
Practice Address - Street 2:
Practice Address - City:GRANTVILLE
Practice Address - State:GA
Practice Address - Zip Code:30220-1945
Practice Address - Country:US
Practice Address - Phone:912-245-0348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-28
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP010830235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist