Provider Demographics
NPI:1588409031
Name:WILLIAMS, ELAINE BRIANNA (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:BRIANNA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5931 GRAYWOOD CIR SE
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-5717
Mailing Address - Country:US
Mailing Address - Phone:585-576-8888
Mailing Address - Fax:
Practice Address - Street 1:4455 STEVE REYNOLDS BLVD
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-3323
Practice Address - Country:US
Practice Address - Phone:585-576-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer