Provider Demographics
NPI:1134836430
Name:WILLIAMSON, JAMES ALBERT
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ALBERT
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 1:705 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-3845
Mailing Address - Country:US
Mailing Address - Phone:469-810-2636
Mailing Address - Fax:
Practice Address - Street 1:705 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-3845
Practice Address - Country:US
Practice Address - Phone:469-810-2636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12475376172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty