Provider Demographics
NPI:1215946538
Name:DURRETT, WILLIAM EDWARD JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EDWARD
Last Name:DURRETT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5110 WOODSIDE EXECUTIVE CT
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-3814
Mailing Address - Country:US
Mailing Address - Phone:803-642-6500
Mailing Address - Fax:803-642-6472
Practice Address - Street 1:5110 WOODSIDE EXECUTIVE CT
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-3814
Practice Address - Country:US
Practice Address - Phone:803-642-6500
Practice Address - Fax:803-649-7551
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC14324208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC143240Medicaid
SCP00435369OtherRR MEDICARE
SCD293587706Medicare PIN
SCP00435369OtherRR MEDICARE