Provider Demographics
NPI:1659352722
Name:WILLIAMS, EDWARD JOSEPH JR (DO)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:JOSEPH
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601888
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1888
Mailing Address - Country:US
Mailing Address - Phone:704-982-1590
Mailing Address - Fax:704-512-4808
Practice Address - Street 1:105 YADKIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3449
Practice Address - Country:US
Practice Address - Phone:704-982-1590
Practice Address - Fax:704-512-4808
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800164207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1111HOtherBCBS
CH3883OtherRAIL ROAD MEDICARE
NC891111HMedicaid
NC1659352722Medicaid
NC2400374CMedicare PIN
NC1659352722Medicaid
NC891111HMedicaid