Provider Demographics
NPI:1659345890
Name:WILLIAMSON, WILLIAM P II (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:P
Last Name:WILLIAMSON
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 ABRAHAM FLEXNER WAY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3826
Mailing Address - Country:US
Mailing Address - Phone:502-584-3376
Mailing Address - Fax:502-584-1385
Practice Address - Street 1:220 ABRAHAM FLEXNER WAY
Practice Address - Street 2:SUITE 500
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3826
Practice Address - Country:US
Practice Address - Phone:502-584-3376
Practice Address - Fax:502-584-1385
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25809208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200024010Medicaid
KY2432688000OtherPASSPORT ADVANTAGE
KY64258098Medicaid
KY1049835OtherPASSPORT
KY000000048657OtherANTHEM
KY61-1086535OtherTAX ID
KY61-1086535OtherTAX ID
KY000000048657OtherANTHEM
KY1049835OtherPASSPORT