Provider Demographics
NPI:1477540961
Name:WILLIAMS, JONATHAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1303 AZALEA CT
Mailing Address - Street 2:STE C
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5765
Mailing Address - Country:US
Mailing Address - Phone:843-692-0570
Mailing Address - Fax:843-497-9566
Practice Address - Street 1:555 E CHEVES ST
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2617
Practice Address - Country:US
Practice Address - Phone:843-669-5162
Practice Address - Fax:843-667-4573
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2016-09-14
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Provider Licenses
StateLicense IDTaxonomies
SC201762085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790530QOtherNC MEDICAID
SC570525838OtherSTANDARD TAX ID
SC300090699OtherRAILROAD MEDICARE
SC0530QOtherBCBS OF NC
SC201766Medicaid
SC154758900OtherUS DEPT OF LABOR
SC154758900OtherFEDERAL BLACK LUNG
SC81364OtherMEDCOST
SC154758900OtherFEDERAL BLACK LUNG
SCG56595Medicare ID - Type UnspecifiedSC MEDICARE