Healthcare Provider Details

I. General information

NPI: 1245193507
Provider Name (Legal Business Name): VITAL GUARD TESTING & COMPLIANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 W MAIN STREET
MORVEN NC
28119
US

IV. Provider business mailing address

PO BOX 142
CHESTERFEILD SC
29709
US

V. Phone/Fax

Practice location:
  • Phone: 980-419-9685
  • Fax:
Mailing address:
  • Phone: 803-878-1437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: TONI ANNETTE BUTLER WILLIAMS
Title or Position: O/O
Credential:
Phone: 803-878-1437