Provider Demographics
NPI:1891854873
Name:WILLIAMS, JAMES O JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:O
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2858 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3420
Mailing Address - Country:US
Mailing Address - Phone:803-699-9073
Mailing Address - Fax:866-527-0937
Practice Address - Street 1:2858 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3420
Practice Address - Country:US
Practice Address - Phone:803-699-9073
Practice Address - Fax:866-527-0937
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14648207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC146489Medicaid
SC146489Medicaid
SCSC12695742Medicare PIN
SCSC12692353Medicare UPIN
E88971Medicare UPIN
SC6661Medicare PIN