Provider Demographics
NPI:1780652438
Name:WILLIAMS, IRMA R (MD)
Entity Type:Individual
Prefix:
First Name:IRMA
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1770 SKYLYN DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1045
Mailing Address - Country:US
Mailing Address - Phone:864-583-8308
Mailing Address - Fax:864-583-8358
Practice Address - Street 1:1770 SKYLYN DR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1045
Practice Address - Country:US
Practice Address - Phone:864-583-8308
Practice Address - Fax:864-583-8358
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCMD14638207LP2900X
LAMD.201331207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4K636Medicare PIN
LA1012891Medicaid