Provider Demographics
NPI:1437934387
Name:WILLIAMSON, ADAM DAVIS (RD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:DAVIS
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 COPPER LEAF PKWY APT 108
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-7780
Mailing Address - Country:US
Mailing Address - Phone:843-858-3369
Mailing Address - Fax:
Practice Address - Street 1:7801 ALEXANDER PROMENADE PL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7351
Practice Address - Country:US
Practice Address - Phone:919-885-1546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL007471133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered