Provider Demographics
NPI:1134723463
Name:WILLIAMSON, TERRY WILSON
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:WILSON
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 1:501 SPAULDING RD
Mailing Address - Street 2:
Mailing Address - City:MONTEZUMA
Mailing Address - State:GA
Mailing Address - Zip Code:31063-1803
Mailing Address - Country:US
Mailing Address - Phone:478-472-7533
Mailing Address - Fax:
Practice Address - Street 1:501 SPAULDING RD
Practice Address - Street 2:
Practice Address - City:MONTEZUMA
Practice Address - State:GA
Practice Address - Zip Code:31063-1803
Practice Address - Country:US
Practice Address - Phone:478-572-7533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013009183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist