Individual
KEITH A WILLIAMSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
135 W RAVINE RD, SUITE 2C, KINGSPORT, TN 37660-3847
(423) 246-7372
(423) 578-4369
Mailing address
135 W RAVINE RD, SUITE 2C, KINGSPORT, TN 37660-3847
(423) 246-7372
(423) 578-4369
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
26502
AL
207W00000X
Ophthalmology Physician
47442
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009933593
—
AL
05
—
051556533
—
AL
01
—
51002085
BCBSAL MAIN PROVIDER #
AL
01
—
51531153
2ND BLUE CROSS PROVIDER #
AL
Enumeration date
04/27/2006
Last updated
08/01/2011
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