Healthcare Provider Details

I. General information

NPI: 1275563629
Provider Name (Legal Business Name): LUTHER CHASE WILLIAMS III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 RICHLAND MEDICAL PARK DR SUITE 110
COLUMBIA SC
29203-6859
US

IV. Provider business mailing address

9 MEDICAL PARK SUITE 200A
COLUMBIA SC
29203
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-7940
  • Fax: 803-434-2262
Mailing address:
  • Phone: 803-434-7956
  • Fax: 803-434-8606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number5571
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: