Basic Information
| Provider Information | |||||||||
| NPI: | 1295107449 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILLIAMSON GYNECOLOGY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 YAMATO RD | ||||||||
| Address2: | SUITE 200 WEST | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334314438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613002410 | ||||||||
| FaxNumber: | 5612357292 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 REGIONAL CIRCLE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | PINEHURST | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28374 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102150111 | ||||||||
| FaxNumber: | 9102150113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2015 | ||||||||
| LastUpdateDate: | 10/28/2015 | ||||||||
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| AuthorizedOfficialLastName: | VALLADARES | ||||||||
| AuthorizedOfficialFirstName: | DINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5613002410 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | UWH OF NORTH CAROLINA, LLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.