Healthcare Provider Details

I. General information

NPI: 1750386827
Provider Name (Legal Business Name): BURSON T WILLIAMS III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3918 MONTCLAIR RD SUITE 100
BIRMINGHAM AL
35213-2425
US

IV. Provider business mailing address

7111 FAIRWAY DR SUITE 400
PALM BEACH GARDENS FL
33418-4204
US

V. Phone/Fax

Practice location:
  • Phone: 205-870-4897
  • Fax: 205-871-4709
Mailing address:
  • Phone: 800-330-6565
  • Fax: 561-712-7349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number14510
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberMD.14510
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: