Provider Demographics
NPI:1902821242
Name:WILLIAMSON, RONDRICK ESHON
Entity Type:Individual
Prefix:DR
First Name:RONDRICK
Middle Name:ESHON
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4144
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-4144
Mailing Address - Country:US
Mailing Address - Phone:784-621-0877
Mailing Address - Fax:478-621-5494
Practice Address - Street 1:770 PINE ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2173
Practice Address - Country:US
Practice Address - Phone:784-621-0877
Practice Address - Fax:478-621-5494
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000931213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000912381DMedicaid
GA000912381DMedicaid
GA5289930001Medicare PIN