Provider Demographics
NPI:1942296181
Name:SCOTT, WILLIAM M III (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:M
Last Name:SCOTT
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 WALL ST
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-6754
Mailing Address - Country:US
Mailing Address - Phone:864-269-7950
Mailing Address - Fax:864-269-7948
Practice Address - Street 1:206 WALL ST
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-6754
Practice Address - Country:US
Practice Address - Phone:864-269-7950
Practice Address - Fax:864-269-7948
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8878207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC088782Medicaid
SC42D1047821OtherCLIA NUMBER
SC830438563OtherFEDERAL ID NUMBER
SCGP4309Medicaid
SC830438563OtherFEDERAL ID NUMBER
SC42D1047821OtherCLIA NUMBER