Provider Demographics
NPI:1154513711
Name:EDDIE M WILLIAMS III MD LLC
Entity type:Organization
Organization Name:EDDIE M WILLIAMS III MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:803-256-4343
Mailing Address - Street 1:2712 MIDDLEBURG DRIVE
Mailing Address - Street 2:SUITE 222
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204
Mailing Address - Country:US
Mailing Address - Phone:803-256-4343
Mailing Address - Fax:803-771-4630
Practice Address - Street 1:2712 MIDDLEBURG DRIVE
Practice Address - Street 2:SUITE 222
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204
Practice Address - Country:US
Practice Address - Phone:803-256-4343
Practice Address - Fax:803-771-4630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11348207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC113488Medicaid
SCDA3683OtherRAILROAD MEDICARE
SC113488Medicaid
SC7760Medicare PIN