Healthcare Provider Details

I. General information

NPI: 1639287279
Provider Name (Legal Business Name): WILLIAM MALCOLM JAMIESON III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4834 SOCIALVILLE FOSTER RD STE 60
MASON OH
45040-6805
US

IV. Provider business mailing address

11595 N MERIDIAN ST STE 375
CARMEL IN
46032-3950
US

V. Phone/Fax

Practice location:
  • Phone: 513-229-8010
  • Fax: 513-229-8014
Mailing address:
  • Phone: 317-575-7304
  • Fax: 317-575-7333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number36174
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: