Provider Demographics
NPI:1215503404
Name:WILLIAMS, KAYLA FAITH
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:FAITH
Last Name: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 1:1033 COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-5413
Mailing Address - Country:US
Mailing Address - Phone:770-316-8553
Mailing Address - Fax:
Practice Address - Street 1:540 LAKE CENTER PKWY STE 107
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-7729
Practice Address - Country:US
Practice Address - Phone:770-205-3939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT015273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist