Provider Demographics
NPI:1972697746
Name:WILLIAMS, JOHNNY LEE (MD)
Entity type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:LEE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 GOVERNMENT CIR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-8198
Mailing Address - Country:US
Mailing Address - Phone:252-413-1637
Mailing Address - Fax:252-317-0316
Practice Address - Street 1:203 GOVERNMENT CIR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-8198
Practice Address - Country:US
Practice Address - Phone:252-413-1637
Practice Address - Fax:252-317-0316
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC205842084A0401X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC34D0944653OtherCLIA
NC87700OtherBCBSNC
NC8987700Medicaid
NC0728888OtherUNITED HEALTHCARE
NC20584OtherMEDICAL LICENSE
NC34D0944653OtherCLIA
NC87700OtherBCBSNC
NC34D0944653OtherCLIA
NC202720-AMedicare ID - Type Unspecified