NPI Code Detail JSON Logo

1114803582 NPI number — KELLY DORRIS WILLIAMSON

NPI Number: 1114803582
Health Care Provider/Practitioner: KELLY DORRIS WILLIAMSON

Information about “1114803582” NPI (KELLY DORRIS WILLIAMSON) exists in 1114803582 in HTML format HTML  |  1114803582 in plain Text format TXT  |  1114803582 in PDF (Portable Document Format) PDF  |  1114803582 in an XML format XML  formats.

NPI Number : 1114803582 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114803582",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILLIAMSON",
    "FirstName": "KELLY",
    "MiddleName": "DORRIS",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "945 N. CENTRAL WOODMERE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WOODMERE",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11958",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3340 PEACHTREE RD NE STE 1800",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ATLANTA",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30326-1064",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "516-206-8900",
    "PracticeLocationAddressFaxNumber": "516-926-0190",
    "EnumerationDate": "08/12/2025",
    "LastUpdateDate": "09/26/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "106S00000X",
        "TaxonomyName": "Behavior Technician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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