Provider Demographics
NPI:1528033198
Name:MIMS, WILLIAM WALTON III (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WALTON
Last Name:MIMS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 30637
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28230-0637
Mailing Address - Country:US
Mailing Address - Phone:704-973-5500
Mailing Address - Fax:704-973-5518
Practice Address - Street 1:1700 SKYLYN DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1041
Practice Address - Country:US
Practice Address - Phone:864-573-3777
Practice Address - Fax:864-573-3261
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16145207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9701066OtherSTATE MEDICAL BOARD
SC16145OtherSTATE MEDICAL BOARD
SCQ50203Medicaid