Healthcare Provider Details

I. General information

NPI: 1396828166
Provider Name (Legal Business Name): HEATHER CLANCY WILLIAMSON O.T.R., C.H.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1960 RIVERSIDE PARKWAY SUITE 104
LAWRENCEVILLE GA
30043
US

IV. Provider business mailing address

595 WATERVIEW TRAIL
ALPHARETTA GA
30022
US

V. Phone/Fax

Practice location:
  • Phone: 770-513-8363
  • Fax: 770-513-8741
Mailing address:
  • Phone: 770-513-8363
  • Fax: 770-513-8741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License Number9711000225
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1111
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: