Provider Demographics
NPI:1073574604
Name:WILLIAMS, JOHN TAYLOR (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TAYLOR
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-679-2661
Mailing Address - Fax:336-679-7056
Practice Address - Street 1:305 E LEE AVE
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-8132
Practice Address - Country:US
Practice Address - Phone:336-679-2661
Practice Address - Fax:336-679-7056
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC30884207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8987954Medicaid
NC203887BMedicare ID - Type Unspecified
NCC82137Medicare UPIN