Healthcare Provider Details

I. General information

NPI: 1396717856
Provider Name (Legal Business Name): DEANNA JO WILLIAMSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 10/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 PROFESSIONAL DR
NEW BERN NC
28560-4547
US

IV. Provider business mailing address

PO BOX 1712
KERNERSVILLE NC
27285-1712
US

V. Phone/Fax

Practice location:
  • Phone: 252-635-9822
  • Fax: 252-635-1822
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number001136776
License Number StateNC

VIII. Authorized Official

Name: JEFF RAGAN
Title or Position: VICE PRESIDENT
Credential:
Phone: 336-345-0678