Healthcare Provider Details

I. General information

NPI: 1932402740
Provider Name (Legal Business Name): MELISSA LEWIS WILLIAMSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2010
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 DANTIGNAC ST STE 2100
AUGUSTA GA
30901-2775
US

IV. Provider business mailing address

4106 COLUMBIA RD STE 103
MARTINEZ GA
30907-1450
US

V. Phone/Fax

Practice location:
  • Phone: 706-396-0600
  • Fax: 706-396-0660
Mailing address:
  • Phone: 706-863-1440
  • Fax: 706-863-5418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5931
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: