Provider Demographics
NPI:1649555178
Name:WILLIAMSON, SUZANNAH J (NP)
Entity type:Individual
Prefix:MRS
First Name:SUZANNAH
Middle Name:J
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E LONG ST
Mailing Address - Street 2:
Mailing Address - City:CLAXTON
Mailing Address - State:GA
Mailing Address - Zip Code:30417-1435
Mailing Address - Country:US
Mailing Address - Phone:912-739-3354
Mailing Address - Fax:912-739-3374
Practice Address - Street 1:501 E LONG ST
Practice Address - Street 2:
Practice Address - City:CLAXTON
Practice Address - State:GA
Practice Address - Zip Code:30417-1435
Practice Address - Country:US
Practice Address - Phone:912-739-3354
Practice Address - Fax:912-739-3374
Is Sole Proprietor?:No
Enumeration Date:2011-10-16
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN169751363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003122891BMedicaid