Individual
SUSAN B WILLIAMSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
6600 VAN AALST BLVD BLDG 9250, FORT MOORE, GA 31905-2102
(706) 545-9114
Mailing address
6600 VAN AALST BLVD BLDG 9250, FORT MOORE, GA 31905-2102
(706) 545-9114
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT000629
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000748822D
PEACH STATE PROVIDER
GA
05
—
000748822D
—
GA
01
—
335026
WELLCARE PROVIDER
GA
01
—
52670844-001
BCBS OF GA PROVIDER
GA
Enumeration date
12/14/2006
Last updated
12/13/2023
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