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General NPI Number Information
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NPI Number | 1750443750
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Entity Type | Organization
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Legal Business Name | JEFFREY R WILLIAMSON DO PC
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 01/20/2020
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Provider Practice Location Address
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Address Line | 6785 MYERS LAKE AVE NE
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City | ROCKFORD
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State | MI
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Zip | 49341
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Country | US
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Telephone | 616-884-5191
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Fax | 616-884-5192
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Provider Business Mailing Address
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Address Line | PO BOX 260 6785 MYERS LAKE AVE NE
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City | ROCKFORD
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State | MI
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Zip | 49341-7416
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Country | US
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Telephone | 616-884-5191
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Fax | 616-884-5192
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | KATHY JO UECKER
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Credential |
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Telephone | 269-420-9404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | JW011762
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License Number State | MI
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