Healthcare Provider Details

I. General information

NPI: 1174061667
Provider Name (Legal Business Name): HILARY WILLIAMSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2017
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E APPLE ST STE 1480
DAYTON OH
45409-2939
US

IV. Provider business mailing address

3170 KETTERING BLVD BLDG B2
MORAINE OH
45439-1924
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-3220
  • Fax: 937-208-3633
Mailing address:
  • Phone: 937-991-3188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.004989RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13231
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: