Individual
TIFFANY WILLIAMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
230 PLAYERS CIR, FAYETTEVILLE, GA 30215-6659
(859) 435-0467
Mailing address
230 PLAYERS CIR, FAYETTEVILLE, GA 30215-6659
(859) 435-0467
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
Other
Enumeration date
02/24/2022
Last updated
02/28/2022
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