1912984790 NPI number — DR. DON E WILLIAMSON MD

Table of content: DR. DON E WILLIAMSON MD (NPI 1912984790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912984790 NPI number — DR. DON E WILLIAMSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMSON
Provider First Name:
DON
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912984790
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
820 ST. SEBASTIAN WAY
Provider Second Line Business Mailing Address:
SUITE 8A
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-722-6900
Provider Business Mailing Address Fax Number:
706-722-5118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
820 ST. SEBASTIAN WAY
Provider Second Line Business Practice Location Address:
SUITE 8A
Provider Business Practice Location Address City Name:
AUGUSTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-722-6900
Provider Business Practice Location Address Fax Number:
706-722-5118
Provider Enumeration Date:
12/22/2005

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: 207RN0300X , with the licence number:  034079 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RN0300X , with the licence number: 30727 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000535719AR , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000535719H , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000535719AK , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000535719AS , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000535719AT , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1912984790 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 390002661 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000535719AQ , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 338219 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000535719Q , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000535719AL , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000535719AP , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000535719N , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000535719P , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10058001 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 000535719AA , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000535719AO , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000535719M , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000535719R , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: G34079 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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