Provider Demographics
NPI:1588664668
Name:WILLIAMS, THOMAS LANDRUM (DC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LANDRUM
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 CHARLES BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5925
Mailing Address - Country:US
Mailing Address - Phone:252-321-9320
Mailing Address - Fax:252-321-9322
Practice Address - Street 1:2415 CHARLES BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5925
Practice Address - Country:US
Practice Address - Phone:252-321-9320
Practice Address - Fax:252-321-9322
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89085JTMedicaid
NCU91841Medicare UPIN
NC2455228Medicare ID - Type Unspecified