Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 0104555922 | VA |
NPI | 1962409557 |
---|---|
Provider Name | Dr. Dana C Williamson |
First Address | Mechanicsville, VA 23111-7536 |
Second Address | Mechanicsville, VA 23116-3834 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2005 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U70469 | (02) | VA |