Provider Demographics
NPI:1629276621
Name:WILLIAMSON, SUSAN W (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:W
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 CEDAR SPRINGS RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-1808
Mailing Address - Country:US
Mailing Address - Phone:214-521-9032
Mailing Address - Fax:
Practice Address - Street 1:2011 CEDAR SPRINGS RD
Practice Address - Street 2:SUITE 103
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-1808
Practice Address - Country:US
Practice Address - Phone:214-521-9032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ80162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXLICENSEOtherJ8016