Provider Demographics
NPI:1902095573
Name:JOHN C. WILLIAMSON, M.D.
Entity Type:Organization
Organization Name:JOHN C. WILLIAMSON, M.D.
Other - Org Name:CAPITOL UROLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-443-5988
Mailing Address - Street 1:4007 JAMES CASEY ST
Mailing Address - Street 2:C150
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-3369
Mailing Address - Country:US
Mailing Address - Phone:512-443-5988
Mailing Address - Fax:512-443-5055
Practice Address - Street 1:3355 CLARK RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-8400
Practice Address - Country:US
Practice Address - Phone:941-309-7284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92630291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8826OtherMEDICARE GROUP NUMBER