Provider Demographics
NPI:1487956470
Name:WILLIAMS, JESSICA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 W WIEUCA RD NE
Mailing Address - Street 2:STE. 120
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3367
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:404-601-5442
Practice Address - Street 1:241 W WIEUCA RD NE
Practice Address - Street 2:STE. 120
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-3367
Practice Address - Country:US
Practice Address - Phone:470-258-2058
Practice Address - Fax:404-601-5442
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003137036EMedicaid