Provider Demographics
NPI:1013918127
Name:WILLIAMSON, DAVID A (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2800 SPRING ARBOR RD STE 102
Mailing Address - Street 2:PO BOX 905
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3895
Mailing Address - Country:US
Mailing Address - Phone:517-783-2612
Mailing Address - Fax:517-783-5991
Practice Address - Street 1:205 N EAST AVE
Practice Address - Street 2:IMAGING DEPARTMENT
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1753
Practice Address - Country:US
Practice Address - Phone:517-783-2612
Practice Address - Fax:517-783-5991
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2017-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010528192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301052819OtherSTATE OF MICHIGAN MEDICAL LICENSE
300020176OtherRAILROAD MEDICARE
MI3103801401OtherBCBS OF MICHIGAN
MI1915052Medicaid
MI4301052819OtherSTATE OF MICHIGAN MEDICAL LICENSE