Provider Demographics
NPI:1265742126
Name:GUILLIAMS, AMY JEAN
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:JEAN
Last Name:GUILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:JEAN
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 UFFLEMAN DR.
Mailing Address - Street 2:SUITE F
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-2975
Mailing Address - Country:US
Mailing Address - Phone:254-833-0505
Mailing Address - Fax:
Practice Address - Street 1:201 UFFLEMAN DR.
Practice Address - Street 2:SUITE F
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2975
Practice Address - Country:US
Practice Address - Phone:254-833-0505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator