Provider Demographics
NPI:1366874190
Name:WILLIAMSON, TIM B (CAC)
Entity type:Individual
Prefix:MR
First Name:TIM
Middle Name:B
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 W 41ST ST
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-2611
Mailing Address - Country:US
Mailing Address - Phone:918-694-1517
Mailing Address - Fax:918-241-9600
Practice Address - Street 1:608 W 41ST ST
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063
Practice Address - Country:US
Practice Address - Phone:918-694-1517
Practice Address - Fax:918-241-9600
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-03
Last Update Date:2018-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK1016171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist