Basic Information
| Provider Information | |||||||||
| NPI: | 1376586594 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMSON | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2821 GEORGE BUSH HWY STE 501 | ||||||||
| Address2: | |||||||||
| City: | RICHARDSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750824278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142391053 | ||||||||
| FaxNumber: | 2142391058 | ||||||||
| Practice Location | |||||||||
| Address1: | 2821 GEORGE BUSH HWY STE 501 | ||||||||
| Address2: | |||||||||
| City: | RICHARDSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750824278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2142391053 | ||||||||
| FaxNumber: | 2142391058 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 10/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | K7949 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 836231 | 05 | AZ | MEDICAID |