Provider Demographics
NPI:1922648542
Name:AKINWUNMI-WILLIAMS, KEMY
Entity Type:Individual
Prefix:
First Name:KEMY
Middle Name:
Last Name:AKINWUNMI-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 1:961 BRIGADE ST
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-4692
Mailing Address - Country:US
Mailing Address - Phone:470-504-2426
Mailing Address - Fax:
Practice Address - Street 1:2059 SCENIC HWY N STE 101
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6141
Practice Address - Country:US
Practice Address - Phone:470-327-9193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-11
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
GA1-21-52633103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician