Provider Demographics
NPI:1245986884
Name:WILLIAMSON, MEAGAN SIMONE (MA, CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:MEAGAN
Middle Name:SIMONE
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 WYNTHROPE RUN
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-5120
Mailing Address - Country:US
Mailing Address - Phone:843-409-9466
Mailing Address - Fax:
Practice Address - Street 1:4605 TIMBER RIDGE DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1224
Practice Address - Country:US
Practice Address - Phone:678-675-1290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP011814235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist