Healthcare Provider Details

I. General information

NPI: 1902821242
Provider Name (Legal Business Name): DR. RONDRICK ESHON WILLIAMSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 PINE ST SUITE 300
MACON GA
31201-2173
US

IV. Provider business mailing address

PO BOX 4144
MACON GA
31208-4144
US

V. Phone/Fax

Practice location:
  • Phone: 784-621-0877
  • Fax: 478-621-5494
Mailing address:
  • Phone: 784-621-0877
  • Fax: 478-621-5494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number000931
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number000931
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: