Healthcare Provider Details

I. General information

NPI: 1528181047
Provider Name (Legal Business Name): DAVID J WILLIAMSON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 12/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 OLD SHELL RD
MOBILE AL
36607-3020
US

IV. Provider business mailing address

704 PROVIDENCE ESTATE DR W
MOBILE AL
36695-4606
US

V. Phone/Fax

Practice location:
  • Phone: 251-654-2828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPY 5277
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number871
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 5277
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number871
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: