Provider Demographics
NPI:1700843323
Name:JAMES TODD WILLIAMS MD
Entity Type:Organization
Organization Name:JAMES TODD WILLIAMS MD
Other - Org Name:ASHEBORO DERMATOLOGY AND SKIN SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:C
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-625-8410
Mailing Address - Street 1:360 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5612
Mailing Address - Country:US
Mailing Address - Phone:336-625-8410
Mailing Address - Fax:336-625-8405
Practice Address - Street 1:360 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203
Practice Address - Country:US
Practice Address - Phone:336-625-8410
Practice Address - Fax:336-625-8405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890103QMedicaid
0103QOtherBCBS
NC890103QMedicaid