MEDICARE: WILLIAMSTON CLINIC CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207R00000X	Internal Medicine Physician
2	207RC0000X	Cardiovascular Disease Physician
3	207RI0011X	Interventional Cardiology Physician
4	207V00000X	Obstetrics & Gynecology Physician
5	207X00000X	Orthopaedic Surgery Physician
6	208600000X	Surgery Physician
7	208M00000X	Hospitalist Physician
8	363A00000X	Physician Assistant
9	363L00000X	Nurse Practitioner
10	207Q00000X	Family Medicine Physician	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	018PT	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0725M	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1811990443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAMSTON CLINIC CORP

Provider Business Mailing Address
First Line	:	PO BOX 19034
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-4085
Country	:	US
Telephone Number	:	615-221-1400
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 MEDICAL DR
Second Line	:
City	:	WILLIAMSTON
State	:	NC
Zip	:	27892-2156
Country	:	US
Telephone Number	:	252-890-6341
Fax Number	:

Authorized Official
Title or Position	:	SR. DIRECTOR PHYSICIAN REV CYCLE
Name	:	LAURA J FEY
Credential	:
Telephone Number	:	615-221-3641

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/07/2023

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Directions to “WILLIAMSTON CLINIC CORP ” Practice Location

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