Provider Demographics
NPI:1992042717
Name:WILLIAMSON, NICOLE LYNN (PHARM D)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 SANDY PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-7833
Mailing Address - Country:US
Mailing Address - Phone:770-578-6627
Mailing Address - Fax:
Practice Address - Street 1:1860 SANDY PLAINS RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-7833
Practice Address - Country:US
Practice Address - Phone:770-578-6627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024481183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist