Healthcare Provider Details

I. General information

NPI: 1619882321
Provider Name (Legal Business Name): SAVANNAH THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 OLD NORCROSS RD STE 100
LAWRENCEVILLE GA
30046-3390
US

IV. Provider business mailing address

130 HARRINGTON LN
LAWRENCEVILLE GA
30046-7465
US

V. Phone/Fax

Practice location:
  • Phone: 678-528-5205
  • Fax:
Mailing address:
  • Phone: 678-910-6486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT010010
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: