Provider Demographics
NPI:1306072293
Name:WILLIAMS, RYAN MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:MICHAEL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N BELTLINE DR STE E
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-7420
Mailing Address - Country:US
Mailing Address - Phone:843-407-8192
Mailing Address - Fax:
Practice Address - Street 1:315 N BELTLINE DR STE E
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-7420
Practice Address - Country:US
Practice Address - Phone:843-407-8192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1415207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC014157Medicaid
SC30125862OtherSELECT HEALTH
SCAA73908552OtherMEDICARE PTAN
SCP01086862OtherRAILROAD MEDICARE
SC255183OtherMEDCOST
SC3748220OtherCIGNA