MEDICARE: DR. DAVID M WILLIAMS III MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207UN0902X	Nuclear Imaging & Therapy Physician	200101409	NC
2	2085R0202X	Diagnostic Radiology Physician	35087964	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205893187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID M WILLIAMS III MD

Provider Business Mailing Address
First Line	:	PO BOX 1885
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29578-1885
Country	:	US
Telephone Number	:	843-692-0570
Fax Number	:	843-692-7641

Provider Business Practice Location Address
First Line	:	1303 AZALEA CT STE B
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5765
Country	:	US
Telephone Number	:	843-692-0570
Fax Number	:	843-692-7641

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	08/21/2024

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