Provider Demographics
NPI:1861107559
Name:WILLIAMS, KRISTEN D (BS, LMT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:D
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:BS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 QUEEN ANNE CT
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-2090
Mailing Address - Country:US
Mailing Address - Phone:317-967-1544
Mailing Address - Fax:
Practice Address - Street 1:1708 QUEEN ANNE CT
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-2090
Practice Address - Country:US
Practice Address - Phone:317-967-1544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT014095225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist