Provider Demographics
NPI:1225038656
Name:WILLIAMS, JOSEPH RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:RUSSELL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RUSSELL
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 EAST MEDICAL LANE
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169
Practice Address - Country:US
Practice Address - Phone:803-936-7210
Practice Address - Fax:803-936-8854
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17961207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3239Medicaid
SCGP3239Medicaid
SCG078517505Medicare ID - Type Unspecified