Provider Demographics
NPI:1497759278
Name:WILLIAMS, LUTHER RAWLS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LUTHER
Middle Name:RAWLS
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4573 OLEANDER DR
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5755
Mailing Address - Country:US
Mailing Address - Phone:843-449-9140
Mailing Address - Fax:843-497-5110
Practice Address - Street 1:4573 OLEANDER DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5755
Practice Address - Country:US
Practice Address - Phone:843-449-9140
Practice Address - Fax:843-497-5110
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC10157207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC101570Medicaid
SCD90739Medicare UPIN
SC101570Medicaid