Provider Demographics
NPI:1750535712
Name:WILLIAMSON, BRANDON MATTHEW (DC)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:MATTHEW
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 HARDY ST
Mailing Address - Street 2:SUITE M
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1300
Mailing Address - Country:US
Mailing Address - Phone:601-450-5060
Mailing Address - Fax:601-261-3295
Practice Address - Street 1:4700 HARDY ST
Practice Address - Street 2:SUITE M
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1300
Practice Address - Country:US
Practice Address - Phone:601-450-5060
Practice Address - Fax:601-261-3295
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1138111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor