Provider Demographics
NPI:1790832871
Name:WILLIAMSON, SHIRLEY T (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:T
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8324
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27835-8324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 EAST 5TH STREET
Practice Address - Street 2:EAST CAROLINA UNIVERSITY STUDENT HEALTH
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-4353
Practice Address - Country:US
Practice Address - Phone:252-328-6841
Practice Address - Fax:252-328-4007
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26414207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG28268Medicare UPIN