=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225384811
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GEORGE A. WILLIAMSON MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2012
-----------------------------------------------------
Last Update Date | 08/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8028 RITCHIE HWY SUITE 309
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21122-1075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-787-7000
-----------------------------------------------------
Fax | 410-787-8608
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8028 RITCHIE HWY SUITE 309
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21122-1075
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-787-7000
-----------------------------------------------------
Fax | 410-787-8608
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/PHYSICIAN
-----------------------------------------------------
Name | DR. GEORGE A WILLIAMSON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 410-787-7000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VX0000X
-----------------------------------------------------
Taxonomy Name | Obstetrics Physician
-----------------------------------------------------
License Number | D0032911
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------