Provider Demographics
NPI:1912230459
Name:WILLIAMSON, PAMELA RENEE (RPH)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:RENEE
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:RENEE
Other - Last Name:WHITMIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:2 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLAXTON
Mailing Address - State:GA
Mailing Address - Zip Code:30417
Mailing Address - Country:US
Mailing Address - Phone:912-739-0406
Mailing Address - Fax:
Practice Address - Street 1:2 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:CLAXTON
Practice Address - State:GA
Practice Address - Zip Code:30417-3041
Practice Address - Country:US
Practice Address - Phone:912-739-0406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015634183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist