Provider Demographics
NPI:1871882068
Name:WILLIAMS, KATRINA GODDARD (MS, LIC-A)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:GODDARD
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MS, LIC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4380 GEORGETOWN SQ
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6254
Mailing Address - Country:US
Mailing Address - Phone:770-220-8434
Mailing Address - Fax:770-234-9979
Practice Address - Street 1:6630 MCGINNIS FERRY RD
Practice Address - Street 2:SUITE B
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-2164
Practice Address - Country:US
Practice Address - Phone:404-297-4230
Practice Address - Fax:770-232-0847
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD003452231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I646336Medicare UPIN