Provider Demographics
NPI:1366873424
Name:WILLIAMSON, PATRICIA
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2366 COUNTY ROAD 198
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35619-9408
Mailing Address - Country:US
Mailing Address - Phone:256-462-1288
Mailing Address - Fax:
Practice Address - Street 1:1210 HIGHWAY 31 NW
Practice Address - Street 2:SUITE CC
Practice Address - City:HARTSELLE
Practice Address - State:AL
Practice Address - Zip Code:35640-4465
Practice Address - Country:US
Practice Address - Phone:256-773-2840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL3464174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist