Basic Information
| Provider Information | |||||||||
| NPI: | 1811990443 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILLIAMSTON CLINIC CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 19034 | ||||||||
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| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049154085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152211400 | ||||||||
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| Practice Location | |||||||||
| Address1: | 104 MEDICAL DR | ||||||||
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| City: | WILLIAMSTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278922156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2528906341 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2005 | ||||||||
| LastUpdateDate: | 08/31/2021 | ||||||||
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| AuthorizedOfficialLastName: | ARWOOD | ||||||||
| AuthorizedOfficialFirstName: | SOPHIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6154657000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207V00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 208600000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 208M00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207Q00000X | NC | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0725M | 01 | NC | BCBS | OTHER | 5905764 | 05 | NC | MEDICAID | 018PT | 01 | NC | BCBS | OTHER | 89012FU | 05 | NC | MEDICAID |