Provider Demographics
NPI:1861846123
Name:WILLIAMSON, RYAN (LMT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2744 WICKLOW DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-3626
Mailing Address - Country:US
Mailing Address - Phone:706-401-9715
Mailing Address - Fax:
Practice Address - Street 1:211 BOBBY JONES EXPY
Practice Address - Street 2:STE C
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-5250
Practice Address - Country:US
Practice Address - Phone:706-860-3355
Practice Address - Fax:706-860-8765
Is Sole Proprietor?:No
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT010895225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist