1073836755 NPI number — MR. JOSEPH ASBURY WILLIAMSON JR.

Table of content: MR. JOSEPH ASBURY WILLIAMSON JR. (NPI 1073836755)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073836755 NPI number — MR. JOSEPH ASBURY WILLIAMSON JR.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMSON
Provider First Name:
JOSEPH
Provider Middle Name:
ASBURY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIAMSON
Provider Other First Name:
JOEY
Provider Other Middle Name:
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1073836755
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 310
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORWAY
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29113-0310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-263-4795
Provider Business Mailing Address Fax Number:
803-263-4809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8412 SAVANNAH HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORWAY
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29113-0310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-263-4795
Provider Business Practice Location Address Fax Number:
803-263-4809
Provider Enumeration Date:
03/09/2010

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: 183500000X , with the licence number:  4469 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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