Provider Demographics
NPI:1619003746
Name:WILLIAMSON, STANFORD ANTHONY (DO)
Entity Type:Individual
Prefix:DR
First Name:STANFORD
Middle Name:ANTHONY
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 SUGARLOAF PKWY
Mailing Address - Street 2:SUITE 400 #290
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1599
Mailing Address - Country:US
Mailing Address - Phone:229-573-0039
Mailing Address - Fax:
Practice Address - Street 1:507 W 3RD AVE STE 8A
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1945
Practice Address - Country:US
Practice Address - Phone:888-589-9064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2022-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060517208100000X, 208VP0014X, 2081P2900X
FLOS10135208100000X, 2081P2900X, 208VP0014X
GA605172081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I253178Medicare PIN
FLHZ677BMedicare PIN