Provider Demographics
NPI:1922015999
Name:RAYBURN, WILLIAM (MD, MBA)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:RAYBURN
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 JOHNNIE DODDS BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3045
Mailing Address - Country:US
Mailing Address - Phone:843-800-1303
Mailing Address - Fax:888-316-7716
Practice Address - Street 1:103 PALM BLVD STE 2A
Practice Address - Street 2:
Practice Address - City:ISLE OF PALMS
Practice Address - State:SC
Practice Address - Zip Code:29451-2165
Practice Address - Country:US
Practice Address - Phone:843-800-1303
Practice Address - Fax:888-316-7716
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM99-106207V00000X
SCMD832762084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology