Provider Demographics
NPI:1346484805
Name:WILLIAMSON, RACHONN SHALETTE (IDMT)
Entity Type:Individual
Prefix:MRS
First Name:RACHONN
Middle Name:SHALETTE
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
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Mailing Address - Street 1:243 CURTISS RD
Mailing Address - Street 2:2 AMDS/SGPF (SUITE 100)
Mailing Address - City:BARKSDALE AFB
Mailing Address - State:LA
Mailing Address - Zip Code:71110-2425
Mailing Address - Country:US
Mailing Address - Phone:318-456-6418
Mailing Address - Fax:318-456-8065
Practice Address - Street 1:243 CURTISS RD
Practice Address - Street 2:ST 100 (2AMDS/SGPF)
Practice Address - City:BARKSDALE AFB
Practice Address - State:LA
Practice Address - Zip Code:71110-2425
Practice Address - Country:US
Practice Address - Phone:318-456-6418
Practice Address - Fax:318-456-8065
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2009-04-30
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians