Provider Demographics
NPI:1295107449
Name:WILLIAMSON GYNECOLOGY
Entity type:Organization
Organization Name:WILLIAMSON GYNECOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLADARES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-300-2410
Mailing Address - Street 1:1501 YAMATO RD
Mailing Address - Street 2:SUITE 200 WEST
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4438
Mailing Address - Country:US
Mailing Address - Phone:561-300-2410
Mailing Address - Fax:561-235-7292
Practice Address - Street 1:3 REGIONAL CIRCLE
Practice Address - Street 2:SUITE B
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374
Practice Address - Country:US
Practice Address - Phone:910-215-0111
Practice Address - Fax:910-215-0113
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UWH OF NORTH CAROLINA, LLP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty