Healthcare Provider Details

I. General information

NPI: 1518076660
Provider Name (Legal Business Name): RANDALL P WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 MEDICAL PARK RD STE 108
MOORESVILLE NC
28117-8529
US

IV. Provider business mailing address

146 MEDICAL PARK RD STE 108
MOORESVILLE NC
28117-8529
US

V. Phone/Fax

Practice location:
  • Phone: 704-662-0877
  • Fax: 704-662-0875
Mailing address:
  • Phone: 704-662-0877
  • Fax: 704-662-0875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number36454
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number36454
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: