Provider Demographics
NPI:1932402740
Name:WILLIAMSON, MELISSA LEWIS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:LEWIS
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4106 COLUMBIA RD
Mailing Address - Street 2:STE 103
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-1450
Mailing Address - Country:US
Mailing Address - Phone:706-863-1440
Mailing Address - Fax:706-863-5418
Practice Address - Street 1:1303 DANTIGNAC ST
Practice Address - Street 2:STE 2100
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2775
Practice Address - Country:US
Practice Address - Phone:706-396-0600
Practice Address - Fax:706-396-0660
Is Sole Proprietor?:No
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5931363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA228745855AMedicaid