MEDICARE: WILLIAMSON PEDIATRIC DENTISTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	9332	TN

General Provider Information

NPI Number	:	1346598042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAMSON PEDIATRIC DENTISTRY

Provider Business Mailing Address
First Line	:	1016 WILLIFORD CT
Second Line	:
City	:	SPRING HILL
State	:	TN
Zip	:	37174-6122
Country	:	US
Telephone Number	:	615-614-1258
Fax Number	:

Provider Business Practice Location Address
First Line	:	2055 WALL STREET
Second Line	:
City	:	SPRING HILL
State	:	TN
Zip	:	37174
Country	:	US
Telephone Number	:	615-614-1258
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT & CEO / PEDIATRIC DENTIST
Name	:	DR. CARL ANDREW WILLIAMSON
Credential	:	D.M.D, M.S.D.
Telephone Number	:	931-626-7989

Provider Enumeration Date	:	08/28/2012
Last Update Date	:	08/28/2012

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