Provider Demographics
NPI:1013495282
Name:WILLIAMSON, LARRESIA HAIRSTON (RN, MSN, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LARRESIA
Middle Name:HAIRSTON
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:RN, MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 HOPE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-2974
Mailing Address - Country:US
Mailing Address - Phone:833-633-4778
Mailing Address - Fax:
Practice Address - Street 1:413 SILVERTOP DR
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-4192
Practice Address - Country:US
Practice Address - Phone:678-458-1877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN172755363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily