MEDICARE: SUSAN W WILLIAMSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	J8016	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LICENSE	OTHER	TX	J8016

General Provider Information

NPI Number	:	1629276621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN W WILLIAMSON MD

Provider Business Mailing Address
First Line	:	2011 CEDAR SPRINGS RD
Second Line	:	SUITE 103
City	:	DALLAS
State	:	TX
Zip	:	75201-1808
Country	:	US
Telephone Number	:	214-521-9032
Fax Number	:

Provider Business Practice Location Address
First Line	:	2011 CEDAR SPRINGS RD
Second Line	:	SUITE 103
City	:	DALLAS
State	:	TX
Zip	:	75201-1808
Country	:	US
Telephone Number	:	214-521-9032
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	07/11/2007

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