Provider Demographics
NPI:1942274394
Name:WILLIAMSON, IVEY (MD)
Entity type:Individual
Prefix:
First Name:IVEY
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 OLD RIDING WAY
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-2053
Mailing Address - Country:US
Mailing Address - Phone:423-322-8393
Mailing Address - Fax:
Practice Address - Street 1:37 OLD RIDING WAY
Practice Address - Street 2:
Practice Address - City:SIGNAL MOUNTAIN
Practice Address - State:TN
Practice Address - Zip Code:37377-2053
Practice Address - Country:US
Practice Address - Phone:423-322-8393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30537207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ023943Medicaid
TN3824195Medicare ID - Type Unspecified