=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659306223
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EUGENE H WILLIAMSON D.D.S.,M.S.,P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4250 WASHINGTON RD
-----------------------------------------------------
City | EVANS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30809-3087
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-860-5074
-----------------------------------------------------
Fax | 706-860-5088
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4250 WASHINGTON RD
-----------------------------------------------------
City | EVANS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30809-3087
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-860-5074
-----------------------------------------------------
Fax | 706-860-5088
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. CATHERINE WILLIAMSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 706-860-5074
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | DN009012
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------