Provider Demographics
NPI:1518167063
Name:WILLIAMSON, EVELYN S (CRNA)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:S
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARY EVELYN
Other - Middle Name:S
Other - Last Name:WILLIAMSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:8624 E STATE HIGHWAY 106
Mailing Address - Street 2:
Mailing Address - City:GEORGIANA
Mailing Address - State:AL
Mailing Address - Zip Code:36033-5534
Mailing Address - Country:US
Mailing Address - Phone:334-376-9652
Mailing Address - Fax:334-376-0039
Practice Address - Street 1:8624 E STATE HIGHWAY 106
Practice Address - Street 2:
Practice Address - City:GEORGIANA
Practice Address - State:AL
Practice Address - Zip Code:36033-5534
Practice Address - Country:US
Practice Address - Phone:334-376-9652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-035964367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered