1851358089 NPI number — MRS. DEBRA FOGELMAN WILLIAMSON PT

Table of content: MRS. DEBRA FOGELMAN WILLIAMSON PT (NPI 1851358089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851358089 NPI number — MRS. DEBRA FOGELMAN WILLIAMSON PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMSON
Provider First Name:
DEBRA
Provider Middle Name:
FOGELMAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOODALL
Provider Other First Name:
DEBRA
Provider Other Middle Name:
FOGELMAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851358089
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 SAINT VINCENT CIR
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72205-5412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-663-6455
Provider Business Mailing Address Fax Number:
501-663-4877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 SAINT VINCENT CIR
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72205-5412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-663-6455
Provider Business Practice Location Address Fax Number:
501-663-4877
Provider Enumeration Date:
05/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  AR1818 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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