Provider Demographics
NPI:1881137354
Name:WILLIAMSON, JOY DELIVERANCE
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:DELIVERANCE
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BODY
Other - Middle Name:INTEGRITY
Other - Last Name:FITNESS, LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MLS CPT, CES
Mailing Address - Street 1:PO BOX 440316
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-0316
Mailing Address - Country:US
Mailing Address - Phone:773-575-4512
Mailing Address - Fax:
Practice Address - Street 1:3863 W FLOURNOY ST
Practice Address - Street 2:APT. 1W
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60624-3617
Practice Address - Country:US
Practice Address - Phone:773-575-4512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILT72685174400000X
IL1506535174400000X
ILMLS243509246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
No174400000XOther Service ProvidersSpecialist