Provider Demographics
NPI:1831760826
Name:WILLIAMSON, CALVIS
Entity type:Individual
Prefix:
First Name:CALVIS
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19670 SW EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34431-3650
Mailing Address - Country:US
Mailing Address - Phone:352-872-6024
Mailing Address - Fax:
Practice Address - Street 1:19670 SW EAGLE DR
Practice Address - Street 2:
Practice Address - City:DUNNELLON
Practice Address - State:FL
Practice Address - Zip Code:34431-3650
Practice Address - Country:US
Practice Address - Phone:352-872-6024
Practice Address - Fax:352-280-2014
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No376J00000XNursing Service Related ProvidersHomemaker