MEDICARE: KEITH A. WILLIAMSON, MD, LLC

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	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1740247261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEITH A. WILLIAMSON, MD, LLC

Provider Business Mailing Address
First Line	:	PO BOX 661495
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35266-1495
Country	:	US
Telephone Number	:	205-979-5882
Fax Number	:	205-979-1248

Provider Business Practice Location Address
First Line	:	1202 ASHLAND HIGHWAY
Second Line	:
City	:	TALLADEGA
State	:	AL
Zip	:	35160
Country	:	US
Telephone Number	:	256-761-2447
Fax Number	:	256-362-4942

Authorized Official
Title or Position	:	OWNER
Name	:	KEITH A. WILLIAMSON
Credential	:	M.D
Telephone Number	:	256-761-2447

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	08/22/2020

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