Provider Demographics
NPI:1669364808
Name:MISSION MEDICAL FAMILY PRACTICE INC.
Entity type:Organization
Organization Name:MISSION MEDICAL FAMILY PRACTICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MEGHANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:386-623-1871
Mailing Address - Street 1:1097 SE VIOLET PL
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-6225
Mailing Address - Country:US
Mailing Address - Phone:386-623-1871
Mailing Address - Fax:
Practice Address - Street 1:1097 SE VIOLET PL
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32025-6225
Practice Address - Country:US
Practice Address - Phone:386-623-1871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty