Provider Demographics
NPI:1144226879
Name:WILLIAMS, RUSSELL WARREN (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:WARREN
Last Name:WILLIAMS
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:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:GARRISONVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22463-0249
Mailing Address - Country:US
Mailing Address - Phone:540-657-9441
Mailing Address - Fax:540-657-4366
Practice Address - Street 1:422 GARRISONVILLE RD
Practice Address - Street 2:STE 111
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1573
Practice Address - Country:US
Practice Address - Phone:540-657-9441
Practice Address - Fax:540-657-4366
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010042941Medicaid
B09348Medicare UPIN
VA002585S09Medicare ID - Type Unspecified