Provider Demographics
NPI:1477540961
Name:WILLIAMS, JONATHAN SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:SCOTT
Last Name:WILLIAMS
Suffix:
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 23321
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-3321
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1329 LAZAR PL
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-5664
Practice Address - Country:US
Practice Address - Phone:843-629-9516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC201762085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790530QOtherNC MEDICAID
SC570525838OtherSTANDARD TAX ID
SC300090699OtherRAILROAD MEDICARE
SC0530QOtherBCBS OF NC
SC201766Medicaid
SC154758900OtherUS DEPT OF LABOR
SC154758900OtherFEDERAL BLACK LUNG
SC81364OtherMEDCOST
SC154758900OtherFEDERAL BLACK LUNG
SCG56595Medicare ID - Type UnspecifiedSC MEDICARE