MEDICARE: IVEY WILLIAMSON MD

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	207R00000X	Internal Medicine Physician	30537	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942274394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVEY WILLIAMSON MD

Provider Business Mailing Address
First Line	:	37 OLD RIDING WAY
Second Line	:
City	:	SIGNAL MOUNTAIN
State	:	TN
Zip	:	37377-2053
Country	:	US
Telephone Number	:	423-322-8393
Fax Number	:

Provider Business Practice Location Address
First Line	:	37 OLD RIDING WAY
Second Line	:
City	:	SIGNAL MOUNTAIN
State	:	TN
Zip	:	37377-2053
Country	:	US
Telephone Number	:	423-322-8393
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	08/12/2024

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