Provider Demographics
NPI:1972851145
Name:ROBERTS, WILLIAM WALTON (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WALTON
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-2286
Mailing Address - Fax:864-455-7848
Practice Address - Street 1:1809 WADE HAMPTON BLVD STE 120
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-4050
Practice Address - Country:US
Practice Address - Phone:864-522-5000
Practice Address - Fax:864-241-9275
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCLL39525208000000X, 207R00000X
SC39525208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC399254Medicaid