Provider Demographics
NPI:1578534673
Name:WILLIAMS, GARY S (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:S
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:999 EXECUTIVE PARK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4632
Mailing Address - Country:US
Mailing Address - Phone:423-224-3250
Mailing Address - Fax:423-224-3258
Practice Address - Street 1:1 CLOVERLEAF SQ
Practice Address - Street 2:SUITE F1
Practice Address - City:BIG STONE GAP
Practice Address - State:VA
Practice Address - Zip Code:24219-2758
Practice Address - Country:US
Practice Address - Phone:276-523-6715
Practice Address - Fax:276-523-6719
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2008-03-25
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Provider Licenses
StateLicense IDTaxonomies
VA0101032208207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64664469Medicaid
B04985Medicare UPIN