Provider Demographics
NPI:1023778826
Name:ALLISON, WILLIAM KEITH (CPS)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:KEITH
Last Name:ALLISON
Suffix:
Gender:M
Credentials:CPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 C GORDON COMMERCIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240
Mailing Address - Country:US
Mailing Address - Phone:706-845-4045
Mailing Address - Fax:
Practice Address - Street 1:153 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30116
Practice Address - Country:US
Practice Address - Phone:770-836-6678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician