Provider Demographics
NPI:1891300612
Name:WILLIAMSON, HEATHER C (MD, PA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:C
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 WILLIS DR
Mailing Address - Street 2:
Mailing Address - City:WEST TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08628
Mailing Address - Country:US
Mailing Address - Phone:609-712-2522
Mailing Address - Fax:
Practice Address - Street 1:57 WILLIS DR
Practice Address - Street 2:
Practice Address - City:WEST TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08628
Practice Address - Country:US
Practice Address - Phone:609-712-2522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000730-P.A.363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical