Healthcare Provider Details

I. General information

NPI: 1174133912
Provider Name (Legal Business Name): WILLIAMS CONSULTANT GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 CHAMPION ST
CAMDEN SC
29020-2206
US

IV. Provider business mailing address

215 CHAMPION ST
CAMDEN SC
29020-2206
US

V. Phone/Fax

Practice location:
  • Phone: 803-563-7844
  • Fax:
Mailing address:
  • Phone: 803-563-7844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: GAZELLA M. WILLIAMS
Title or Position: PERSONAL GERIATRIC ADVOCATE
Credential: MA
Phone: 803-563-7844