Provider Demographics
NPI:1912328097
Name:WILLIAMSON, BRANDON (MED, ATC/L, CSCS)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:MED, ATC/L, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 TALON CT
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30145-1868
Mailing Address - Country:US
Mailing Address - Phone:706-455-5212
Mailing Address - Fax:
Practice Address - Street 1:16 TALON CT
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:GA
Practice Address - Zip Code:30145-1868
Practice Address - Country:US
Practice Address - Phone:706-455-5212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-17
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0014582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer