Provider Demographics
NPI:1932116209
Name:WILLIAMS, MISTY LEIGH (MD)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:LEIGH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 PARKWOOD DR.
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520
Mailing Address - Country:US
Mailing Address - Phone:843-237-3378
Mailing Address - Fax:843-237-5073
Practice Address - Street 1:2415 PARKWOOD DR.
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520
Practice Address - Country:US
Practice Address - Phone:912-466-7188
Practice Address - Fax:843-237-5073
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064741207R00000X
GA063051208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD411055200Medicaid
MD89031201OtherBCBS
DC0024OtherBCBS
MDP00341246OtherRAILROAD MEDICARE
WV3810005966Medicaid
MD411055200Medicaid
MD854MO309Medicare PIN