Provider Demographics
NPI:1235164666
Name:WILLIAMS, LAWRENCE DALE (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:DALE
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 1:624 QUAKER LN
Mailing Address - Street 2:STE.207C
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-3832
Mailing Address - Country:US
Mailing Address - Phone:336-883-2500
Mailing Address - Fax:336-883-9728
Practice Address - Street 1:319 WESTWOOD AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4323
Practice Address - Country:US
Practice Address - Phone:336-878-3419
Practice Address - Fax:336-878-6420
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27342208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7987808Medicaid
NC020031234OtherRR MEDICARE
NC211571MMedicare PIN
NC7987808Medicaid
C87185Medicare UPIN