Basic Information
| Provider Information | |||||||||
| NPI: | 1538119482 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMSON | ||||||||
| FirstName: | BARRY | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 N ELM ST | ||||||||
| Address2: | |||||||||
| City: | LUMBERTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283583011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102723051 | ||||||||
| FaxNumber: | 9107383764 | ||||||||
| Practice Location | |||||||||
| Address1: | 3001 N ELM ST | ||||||||
| Address2: | |||||||||
| City: | LUMBERTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107388556 | ||||||||
| FaxNumber: | 9107382275 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 09/23/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 9500477 | NC | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 891311T | 05 | NC | MEDICAID |