Provider Demographics
NPI:1245329564
Name:WILLIAMS, PATRICIA I (PT)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:I
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 CHESTNUT LAKE DR NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4215
Mailing Address - Country:US
Mailing Address - Phone:770-509-7818
Mailing Address - Fax:
Practice Address - Street 1:1501 MILSTEAD RD
Practice Address - Street 2:SUITE 170
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-5223
Practice Address - Country:US
Practice Address - Phone:770-922-2420
Practice Address - Fax:770-922-1096
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002350225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist