Provider Demographics
NPI:1164574638
Name:WILLIAMSON, CARLENE TEAL (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARLENE
Middle Name:TEAL
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4219 COTTAGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-4216
Mailing Address - Country:US
Mailing Address - Phone:251-661-6100
Mailing Address - Fax:251-661-6106
Practice Address - Street 1:4219 COTTAGE HILL RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-4216
Practice Address - Country:US
Practice Address - Phone:251-661-6100
Practice Address - Fax:251-661-6106
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL44121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice