Provider Demographics
NPI:1063879948
Name:WILLIAMS, MELINDA (CAC 1)
Entity type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CAC 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 LANGFORD RD.
Mailing Address - Street 2:
Mailing Address - City:RANGER
Mailing Address - State:GA
Mailing Address - Zip Code:30734
Mailing Address - Country:US
Mailing Address - Phone:706-291-7201
Mailing Address - Fax:706-291-7198
Practice Address - Street 1:106 LANGFORD RD.
Practice Address - Street 2:
Practice Address - City:RANGER
Practice Address - State:GA
Practice Address - Zip Code:30734-9540
Practice Address - Country:US
Practice Address - Phone:706-291-7201
Practice Address - Fax:706-291-7198
Is Sole Proprietor?:No
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1864101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)