Healthcare Provider Details

I. General information

NPI: 1477967859
Provider Name (Legal Business Name): KATELIN JEAN WILLIAMSON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 GRACERN RD STE 120
COLUMBIA SC
29210-7657
US

IV. Provider business mailing address

PO BOX 743904
ATLANTA GA
30374-3904
US

V. Phone/Fax

Practice location:
  • Phone: 803-296-2585
  • Fax: 803-551-2585
Mailing address:
  • Phone: 803-296-7330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number36709
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: