Provider Demographics
NPI:1811053952
Name:WILLIAMS, VANESSA P (EDS)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:P
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 OXFORD DR SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-6409
Mailing Address - Country:US
Mailing Address - Phone:770-918-0499
Mailing Address - Fax:770-918-0499
Practice Address - Street 1:1300 OXFORD DR SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-6409
Practice Address - Country:US
Practice Address - Phone:770-918-0499
Practice Address - Fax:770-918-0499
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001363235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist