Provider Demographics
NPI:1386234953
Name:WILLIAMSON, MELISSA (MED/ CCC-SLP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:MED/ CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 BOWENS MILL RD SW
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-3926
Mailing Address - Country:US
Mailing Address - Phone:912-331-0846
Mailing Address - Fax:678-792-4894
Practice Address - Street 1:400 ADAMS ST UNIT B
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-4817
Practice Address - Country:US
Practice Address - Phone:478-254-0636
Practice Address - Fax:912-525-2847
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP011852235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GASLP011852Medicaid