Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 0101264099 | VA |
NPI | 1003234204 |
---|---|
Provider Name | Ryan Williamson |
First Address | Camp Lejeune, NC 28547-2575 |
Second Address | Camp Lejeune, NC 28547-2575 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2014 |
Last Update Date | 15/09/2021 |