Provider Demographics
NPI:1568402113
Name:IVEY, WILLIAM J JR (PT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:J
Last Name:IVEY
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4060 INVERNESS XING
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4781
Mailing Address - Country:US
Mailing Address - Phone:404-823-8157
Mailing Address - Fax:888-877-6415
Practice Address - Street 1:4060 INVERNESS XING
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4781
Practice Address - Country:US
Practice Address - Phone:404-823-8157
Practice Address - Fax:888-877-6415
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5195225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5195OtherPT#