Healthcare Provider Details

I. General information

NPI: 1144151614
Provider Name (Legal Business Name): JUSTIN MICHAEL WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MACCORKLE AVE SE
CHARLESTON WV
25304-1227
US

IV. Provider business mailing address

105 BELFAST RD UNIT 2
CHARLESTON WV
25314-2120
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-1020
  • Fax: 304-388-1021
Mailing address:
  • Phone: 304-767-0196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: