Provider Demographics
NPI:1164661203
Name:WILLIAMS, RONALD LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:LYNN
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 1:2203 DARIEN PL NW
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-1583
Mailing Address - Country:US
Mailing Address - Phone:252-237-3483
Mailing Address - Fax:
Practice Address - Street 1:6631 WARD BLVD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-5963
Practice Address - Country:US
Practice Address - Phone:252-236-1929
Practice Address - Fax:252-236-1929
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27649207PS0010X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C81908OtherUPIN
NC8987903Medicaid
NC8987903Medicaid