Provider Demographics
NPI:1902860992
Name:WILLIAMS, JOHN D (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 DALLAS HWY STE 203
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-1263
Mailing Address - Country:US
Mailing Address - Phone:770-459-4555
Mailing Address - Fax:770-459-2550
Practice Address - Street 1:690 DALLAS HWY STE 203
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1263
Practice Address - Country:US
Practice Address - Phone:770-459-4550
Practice Address - Fax:770-459-2550
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000921203AMedicaid