Healthcare Provider Details

I. General information

NPI: 1548237217
Provider Name (Legal Business Name): EDWIN O. WILLIAMSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 MEDICAL PLAZA DR
CHARLESTON SC
29406-9104
US

IV. Provider business mailing address

PO BOX 49009
GREENWOOD SC
29649-0001
US

V. Phone/Fax

Practice location:
  • Phone: 864-223-3070
  • Fax: 864-223-1396
Mailing address:
  • Phone: 864-223-3070
  • Fax: 864-223-1396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number7012
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number7012
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: