Provider Demographics
NPI:1285921122
Name:WILLIAMSON, TATIYANA L
Entity type:Individual
Prefix:MS
First Name:TATIYANA
Middle Name:L
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 MACLAND RD STE 205
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-8212
Mailing Address - Country:US
Mailing Address - Phone:770-222-1344
Mailing Address - Fax:770-222-1345
Practice Address - Street 1:4150 MACLAND RD STE 205
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127-8212
Practice Address - Country:US
Practice Address - Phone:770-222-1344
Practice Address - Fax:770-222-1345
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant