Healthcare Provider Details

I. General information

NPI: 1932237294
Provider Name (Legal Business Name): GENEVIEVE ANNE WILLIAMSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 BECKNER RD
SANTA FE NM
87507-3691
US

IV. Provider business mailing address

4730 BECKNER RD
SANTA FE NM
87507-3691
US

V. Phone/Fax

Practice location:
  • Phone: 505-989-4500
  • Fax: 505-443-2913
Mailing address:
  • Phone: 505-989-4500
  • Fax: 505-443-2913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD2024-0728
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD2024-0728
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: