Provider Demographics
NPI:1710652615
Name:WILLIAMSON, KEVIN PAUL (BS)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:PAUL
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:BS
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Mailing Address - Street 1:1200 N STATE ST STE 330
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2027
Mailing Address - Country:US
Mailing Address - Phone:601-353-2020
Mailing Address - Fax:601-352-5988
Practice Address - Street 1:1200 N STATE ST STE 330
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2027
Practice Address - Country:US
Practice Address - Phone:601-353-2020
Practice Address - Fax:601-352-5988
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1900XEye and Vision Services ProvidersTechnician/TechnologistOrthoptist