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General NPI Number Information
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NPI Number | 1679685929
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Entity Type | Individual
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Provider Name | MARK BASCOM WILLIAMSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 02/19/2008
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Provider Practice Location Address
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Address Line | 218 OLD MOCKSVILLE RD
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City | STATESVILLE
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State | NC
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Zip | 28625-1930
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Country | US
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Telephone | 704-838-7091
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Fax | 704-838-7093
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Provider Business Mailing Address
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Address Line | PO BOX 746
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City | STATESVILLE
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State | NC
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Zip | 28687-0746
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Country | US
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Telephone | 704-838-7091
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Fax | 704-838-7093
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 97-00161
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License Number State | NC
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