Provider Demographics
NPI:1598580557
Name:WILLIAMS, JESSICA WHITE (DPT)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:WHITE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2427 HIGHWAY 198
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:GA
Mailing Address - Zip Code:30511-3810
Mailing Address - Country:US
Mailing Address - Phone:706-654-8641
Mailing Address - Fax:
Practice Address - Street 1:1242 HISTORIC HOMER HWY
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:GA
Practice Address - Zip Code:30547-2737
Practice Address - Country:US
Practice Address - Phone:762-339-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist