Healthcare Provider Details

I. General information

NPI: 1992254833
Provider Name (Legal Business Name): JUSTIN TIMOTHY WILLIAMS OT, MSOT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

254 ROBERT C DANIEL JR PKWY STE 4
AUGUSTA GA
30909-0812
US

IV. Provider business mailing address

6397 LEE HWY STE 300
CHATTANOOGA TN
37421-4915
US

V. Phone/Fax

Practice location:
  • Phone: 706-723-5795
  • Fax: 706-723-5831
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT006579
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: