Healthcare Provider Details

I. General information

NPI: 1881519379
Provider Name (Legal Business Name): SELENA WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3107 CLAIRMONT RD NE STE A
BROOKHAVEN GA
30329-1007
US

IV. Provider business mailing address

1854 AUBURN RD STE 101
DACULA GA
30019-1130
US

V. Phone/Fax

Practice location:
  • Phone: 470-355-3460
  • Fax: 770-904-2357
Mailing address:
  • Phone: 770-904-6009
  • Fax: 770-904-2357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT010013
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: