Provider Demographics
NPI:1205893187
Name:WILLIAMS, DAVID M III (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:WILLIAMS
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:PO BOX 1885
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29578-1885
Mailing Address - Country:US
Mailing Address - Phone:843-692-0570
Mailing Address - Fax:843-692-7641
Practice Address - Street 1:1303 AZALEA CT STE B
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-5765
Practice Address - Country:US
Practice Address - Phone:843-692-0570
Practice Address - Fax:843-692-7641
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101409207UN0902X
OH350879642085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2664157Medicaid
OHWI4185121Medicare PIN
I54846Medicare UPIN
OHWI4185122Medicare PIN