Provider Demographics
NPI:1649320391
Name:WILLIAMSON, MARGARET KENNEDY (RD)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:KENNEDY
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:
Other - Last Name:KENNEDY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:221 TECHNOLOGY PKWY NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1369
Mailing Address - Country:US
Mailing Address - Phone:762-235-1000
Mailing Address - Fax:
Practice Address - Street 1:150 GENTILLY BLVD
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-8522
Practice Address - Country:US
Practice Address - Phone:470-490-6511
Practice Address - Fax:770-382-5762
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD002661133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA977614711DMedicaid
GA977614711CMedicaid
GA977614711AMedicaid
GA977614711BMedicaid
Q42065Medicare UPIN
GA977614711CMedicaid