=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417411745
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL E. WILLIAMSON D.M.D, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2019
-----------------------------------------------------
Last Update Date | 06/11/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 MEDICAL CENTER PKWY
-----------------------------------------------------
City | BOAZ
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35957-5938
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-593-3211
-----------------------------------------------------
Fax | 256-593-3225
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 701 MEDICAL CENTER PKWY
-----------------------------------------------------
City | BOAZ
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35957-5938
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-593-3211
-----------------------------------------------------
Fax | 256-593-3225
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | DR. MICHAEL EDWARD WILLIAMSON
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 256-593-3211
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------