Healthcare Provider Details

I. General information

NPI: 1710249966
Provider Name (Legal Business Name): GARY WILLIAMSON, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2258 WRIGHTSBORO RD SUITE 180
AUGUSTA GA
30904-4887
US

IV. Provider business mailing address

2258 WRIGHTSBORO RD SUITE 180
AUGUSTA GA
30904-4887
US

V. Phone/Fax

Practice location:
  • Phone: 706-737-8827
  • Fax: 706-737-8916
Mailing address:
  • Phone: 706-737-8827
  • Fax: 706-737-8916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number23314
License Number StateGA

VIII. Authorized Official

Name: GARY B WILLIAMSON
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 706-737-8827