Organization Active NPI

G. Scott Williamson O.D., P.C.

  • Optometrist
  • Tyrone, GA
National Provider Identifier
1215095302
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
001221 Issued in GA
Legal business name
G. SCOTT WILLIAMSON O.D., P.C.
Practice address
179 Handley Rd
Suite C
Tyrone, GA 30290-2154
Phone
(770) 486-1020
Fax
(770) 486-1280
NPI assigned
Dec 4, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Dr. Gregory Scott Williamson, O.D.NPI 1467510545
Title
President
Phone
(770) 486-1020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20040420001209 GA Part B Supplier - Clinic/Group Practice 8921093618 Receives reassigned benefits from 3 practitioners
Practice locations: Tyrone, GA; Senoia, GA

National Provider Directory

National Provider Directory

Locations

3415 Highway 5
Ste B
Douglasville, GA 30135
Phone (770) 949-2020

7280 Highway 16
Ste F
Senoia, GA 30276
Phone (770) 727-6687

179 Handley Rd
Ste C
Tyrone, GA 30290
Phone (770) 486-1020

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 001221 GA Primary

Addresses

NPPES NPI Registry

Primary practice location

179 Handley Rd
Suite C
Tyrone, GA 30290-2154

Mailing address

179 Handley Rd
Suite C
Tyrone, GA 30290-2154
Phone (770) 486-1020

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
000425972BMedicaidGA

Other names 1

NPPES NPI Registry
  • Williamson Eye Care Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215095302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "179 HANDLEY RD",
            "address_2": "SUITE C",
            "city": "TYRONE",
            "state": "GA",
            "postal_code": "302902154",
            "telephone_number": "770-486-1020",
            "fax_number": "770-486-1280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "179 HANDLEY RD",
            "address_2": "SUITE C",
            "city": "TYRONE",
            "state": "GA",
            "postal_code": "302902154",
            "telephone_number": "770-486-1020",
            "fax_number": "770-486-1280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "G. SCOTT WILLIAMSON O.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILLIAMSON",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-486-1020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "001221",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000425972B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Williamson Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tyrone, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.