Provider Demographics
NPI:1659734499
Name:WILLIAMS, GWENDOLYN
Entity Type:Individual
Prefix:MRS
First Name:GWENDOLYN
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 1:935 US HIGHWAY 72 E
Mailing Address - Street 2:SUITE B 35611
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-4363
Mailing Address - Country:US
Mailing Address - Phone:256-233-0073
Mailing Address - Fax:
Practice Address - Street 1:935 US HIGHWAY 72 E
Practice Address - Street 2:SUITE B 35611
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-4363
Practice Address - Country:US
Practice Address - Phone:256-233-0073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner