Provider Demographics
NPI:1437107836
Name:WILLIAMS, BRADLEY B (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:B
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 1:113 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-5608
Mailing Address - Country:US
Mailing Address - Phone:864-269-3333
Mailing Address - Fax:864-295-1288
Practice Address - Street 1:113 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5608
Practice Address - Country:US
Practice Address - Phone:864-269-3333
Practice Address - Fax:864-295-1288
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13073207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCC609841571OtherMEDICARE UPIN GROUP GREENVILLE OFFICE
SCC609846180OtherMEDICARE UPIN GREER OFFICE
SC130735Medicaid
SCC609847951OtherGHS MEDICARE PTAN
SCC609841571OtherMEDICARE UPIN GROUP GREENVILLE OFFICE