Provider Demographics
NPI:1871288589
Name:WILLIAMS, DONOVAN
Entity type:Individual
Prefix:MR
First Name:DONOVAN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1992 WINDSOR CREEK DR SW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-5810
Mailing Address - Country:US
Mailing Address - Phone:562-743-8581
Mailing Address - Fax:
Practice Address - Street 1:1992 WINDSOR CREEK DR SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-5810
Practice Address - Country:US
Practice Address - Phone:562-743-8581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician