Provider Demographics
NPI:1669464855
Name:WILLIAMS, CARLOS A (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:M
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:PO BOX 654
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-0654
Mailing Address - Country:US
Mailing Address - Phone:434-447-9033
Mailing Address - Fax:434-447-9034
Practice Address - Street 1:501 LOMBARDY ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-2107
Practice Address - Country:US
Practice Address - Phone:434-447-9033
Practice Address - Fax:434-447-9034
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010548172084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89063V9Medicaid
VA130023188OtherRAILROAD MEDICARE
VA285322OtherANTHEM
VA007116241Medicaid
NC89063V9Medicaid
VA007116241Medicaid