Healthcare Provider Details

I. General information

NPI: 1962609347
Provider Name (Legal Business Name): DAVID TERRELL WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SAINT FRANCIS DR STE 330
GREENVILLE SC
29601-3971
US

IV. Provider business mailing address

3 SAINT FRANCIS DR STE 330
GREENVILLE SC
29601-3971
US

V. Phone/Fax

Practice location:
  • Phone: 864-255-1834
  • Fax:
Mailing address:
  • Phone: 864-255-1834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number37311
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: