Provider Demographics
NPI:1851739023
Name:WILLIAMSON, MARLON CHAD (MD)
Entity Type:Individual
Prefix:
First Name:MARLON
Middle Name:CHAD
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 GAULT AVE N
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35967
Mailing Address - Country:US
Mailing Address - Phone:256-979-1633
Mailing Address - Fax:256-304-5456
Practice Address - Street 1:617 GAULT AVE N
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967
Practice Address - Country:US
Practice Address - Phone:256-979-1633
Practice Address - Fax:256-304-5456
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.33688207P00000X
GA72744207R00000X
AL33688207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine