Provider Demographics
NPI:1568638385
Name:WILLIAMSON, ERNIE GLEN (MD)
Entity type:Individual
Prefix:DR
First Name:ERNIE
Middle Name:GLEN
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:NORTH CENTRAL COMMUNITY HEALTH CENTER
Mailing Address - Street 2:4000 JENNINGS STATION RD
Mailing Address - City:PINE LAWN
Mailing Address - State:MO
Mailing Address - Zip Code:63121-3323
Mailing Address - Country:US
Mailing Address - Phone:314-615-7900
Mailing Address - Fax:
Practice Address - Street 1:NORTH CENTRAL COMMUNITY HEALTH CENTER
Practice Address - Street 2:4000 JENNINGS STATION RD
Practice Address - City:PINE LAWN
Practice Address - State:MO
Practice Address - Zip Code:63121-3323
Practice Address - Country:US
Practice Address - Phone:314-615-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator