MEDICARE: WILLIAMSON PEDIATRICS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1336929645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAMSON PEDIATRICS, PLLC

Provider Business Mailing Address
First Line	:	4988 FAIRFIELD CIR S
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38117-4210
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4988 FAIRFIELD CIR S
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38117-4210
Country	:	US
Telephone Number	:	901-827-1114
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	REBEKAH GRACE WILLIAMSON
Credential	:	BCBA
Telephone Number	:	901-827-1114

Provider Enumeration Date	:	10/03/2023
Last Update Date	:	10/03/2023

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