Healthcare Provider Details

I. General information

NPI: 1205893187
Provider Name (Legal Business Name): DAVID M WILLIAMS III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 08/21/2024
Certification Date: 08/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 AZALEA CT STE B
MYRTLE BEACH SC
29577-5765
US

IV. Provider business mailing address

PO BOX 1885
MYRTLE BEACH SC
29578-1885
US

V. Phone/Fax

Practice location:
  • Phone: 843-692-0570
  • Fax: 843-692-7641
Mailing address:
  • Phone: 843-692-0570
  • Fax: 843-692-7641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number200101409
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35087964
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2664157
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: