=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780030437
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IAN WILLIAMSON STATEN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2016
-----------------------------------------------------
Last Update Date | 02/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2817 ROCK MERRITT AVE
-----------------------------------------------------
City | FORT BRAGG
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28310-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-907-8922
-----------------------------------------------------
Fax | 910-907-6069
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2817 ROCK MERRITT AVE
-----------------------------------------------------
City | FORT LIBERTY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28310-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-907-8922
-----------------------------------------------------
Fax | 910-907-6069
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 2019-01755
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------