Provider Demographics
NPI:1386865921
Name:WILLIAMSON, JUDY T (CNM)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:T
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 UPPER RIVERDALE ROAD
Mailing Address - Street 2:BLDG 2 SUITE 135
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274
Mailing Address - Country:US
Mailing Address - Phone:770-991-0778
Mailing Address - Fax:
Practice Address - Street 1:83 UPPER RIVERDALE ROAD
Practice Address - Street 2:BLDG 2 SUITE 135
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274
Practice Address - Country:US
Practice Address - Phone:770-991-0778
Practice Address - Fax:770-991-7390
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN145364176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00857601DMedicaid