Healthcare Provider Details

I. General information

NPI: 1740247261
Provider Name (Legal Business Name): KEITH A. WILLIAMSON, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 ASHLAND HIGHWAY
TALLADEGA AL
35160
US

IV. Provider business mailing address

PO BOX 661495
BIRMINGHAM AL
35266-1495
US

V. Phone/Fax

Practice location:
  • Phone: 256-761-2447
  • Fax: 256-362-4942
Mailing address:
  • Phone: 205-979-5882
  • Fax: 205-979-1248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: KEITH A. WILLIAMSON
Title or Position: OWNER
Credential: M.D
Phone: 256-761-2447