Individual
JACKIE L. WILLIAMSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
9766 HWY 92, SUITE 200, WOODSTOCK, GA 30188
(770) 926-9846
(770) 693-9859
Mailing address
9766 HIGHWAY 92 STE 200, WOODSTOCK, GA 30188-6456
(770) 926-9846
(770) 693-9859
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
030925
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202I088114
MEDICARE PTAN
GA
Enumeration date
10/02/2006
Last updated
08/01/2019
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