Provider Demographics
NPI:1790008977
Name:WILLIAMSON, GERALDINE ANNETTE (BSN)
Entity Type:Individual
Prefix:MRS
First Name:GERALDINE
Middle Name:ANNETTE
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4023 US HIGHWAY 52
Mailing Address - Street 2:
Mailing Address - City:COWARD
Mailing Address - State:SC
Mailing Address - Zip Code:29530-5379
Mailing Address - Country:US
Mailing Address - Phone:843-389-3497
Mailing Address - Fax:
Practice Address - Street 1:4023 US HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:COWARD
Practice Address - State:SC
Practice Address - Zip Code:29530-5379
Practice Address - Country:US
Practice Address - Phone:843-389-3497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC210564163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3056875Medicaid