Provider Demographics
NPI:1740592476
Name:DRS. WILLIAMSON & GILLESPIE, PA
Entity Type:Organization
Organization Name:DRS. WILLIAMSON & GILLESPIE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-531-2300
Mailing Address - Street 1:1175 COOK RD
Mailing Address - Street 2:SUITE 145
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-8201
Mailing Address - Country:US
Mailing Address - Phone:803-531-2300
Mailing Address - Fax:803-531-0133
Practice Address - Street 1:1175 COOK RD
Practice Address - Street 2:SUITE 145
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-8201
Practice Address - Country:US
Practice Address - Phone:803-531-2300
Practice Address - Fax:803-531-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9916261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRHC190Medicaid
SC423868Medicare PIN