Provider Demographics
NPI:1457927998
Name:WILLIAMSON, JOANNA ROSE (AGNP)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:ROSE
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:ROSE
Other - Last Name:INMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGNP
Mailing Address - Street 1:670 W ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:RANDLEMAN
Mailing Address - State:NC
Mailing Address - Zip Code:27317-9748
Mailing Address - Country:US
Mailing Address - Phone:336-498-8500
Mailing Address - Fax:336-498-8522
Practice Address - Street 1:670 W ACADEMY ST
Practice Address - Street 2:
Practice Address - City:RANDLEMAN
Practice Address - State:NC
Practice Address - Zip Code:27317-9748
Practice Address - Country:US
Practice Address - Phone:336-498-8500
Practice Address - Fax:336-498-8522
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014497207Q00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine