Healthcare Provider Details

I. General information

NPI: 1376545301
Provider Name (Legal Business Name): JAMES TODD WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 SUNSET AVE
ASHEBORO NC
27203-5612
US

IV. Provider business mailing address

360 SUNSET AVE
ASHEBORO NC
27203-5612
US

V. Phone/Fax

Practice location:
  • Phone: 336-625-8410
  • Fax: 336-625-8405
Mailing address:
  • Phone: 336-625-8410
  • Fax: 336-625-8405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number36131
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: