Provider Demographics
NPI:1285271031
Name:WILLIAMSON, TAYLOR R (OD)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:R
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:TAYLOR
Other - Middle Name:R
Other - Last Name:WREGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:179 HANDLEY RD STE C
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-2152
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:179 HANDLEY RD STE C
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2152
Practice Address - Country:US
Practice Address - Phone:770-486-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-27
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003211152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist