Provider Demographics
NPI:1629516430
Name:WILLIAMSON MEDICAL DISTRIBUTION INC.
Entity Type:Organization
Organization Name:WILLIAMSON MEDICAL DISTRIBUTION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-840-8948
Mailing Address - Street 1:3900 LASSITER MILL RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6414
Mailing Address - Country:US
Mailing Address - Phone:919-840-8948
Mailing Address - Fax:919-882-8187
Practice Address - Street 1:3900 LASSITER MILL RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6414
Practice Address - Country:US
Practice Address - Phone:919-840-8948
Practice Address - Fax:919-882-8187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies