Provider Demographics
NPI:1427013002
Name:WILLIAMS, RANDALL WATTS (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:WATTS
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 1:3809 COMPUTER DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6518
Mailing Address - Country:US
Mailing Address - Phone:919-782-6700
Mailing Address - Fax:919-782-2218
Practice Address - Street 1:3809 COMPUTER DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6518
Practice Address - Country:US
Practice Address - Phone:919-782-6700
Practice Address - Fax:919-782-2218
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32213207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1462144OtherUHC
012CTOtherBCBS
C89606Medicare UPIN
2141132EMedicare ID - Type Unspecified