Provider Demographics
NPI:1518068873
Name:WILLIAMS, MARVA DENISE (MD)
Entity Type:Individual
Prefix:
First Name:MARVA
Middle Name:DENISE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-2904
Mailing Address - Country:US
Mailing Address - Phone:803-435-4447
Mailing Address - Fax:803-435-9092
Practice Address - Street 1:107 SUNSET DR
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-2904
Practice Address - Country:US
Practice Address - Phone:803-435-4447
Practice Address - Fax:803-435-9092
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22121207PE0004X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1689194060OtherNPI
SCH243729326Medicare PIN
SCH24372Medicare UPIN