Provider Demographics
NPI:1164002507
Name:WILLIAMSON, SHAMEKA DONIEDRE
Entity type:Individual
Prefix:
First Name:SHAMEKA
Middle Name:DONIEDRE
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAMEKA
Other - Middle Name:DONIEDRE
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:190 GENTLE DOE DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-8205
Mailing Address - Country:US
Mailing Address - Phone:318-547-1745
Mailing Address - Fax:
Practice Address - Street 1:37 CALUMET PKWY BLDG J
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-6734
Practice Address - Country:US
Practice Address - Phone:770-683-6946
Practice Address - Fax:770-683-6949
Is Sole Proprietor?:No
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional