Healthcare Provider Details

I. General information

NPI: 1114538642
Provider Name (Legal Business Name): WILLIAM SLATER APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 06/28/2025
Certification Date: 06/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6439 GARNERS FERRY RD
COLUMBIA SC
29209-1638
US

IV. Provider business mailing address

6439 GARNERS FERRY RD
COLUMBIA SC
29209-1638
US

V. Phone/Fax

Practice location:
  • Phone: 803-497-4937
  • Fax: 803-695-6892
Mailing address:
  • Phone: 803-497-4937
  • Fax: 803-695-6892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11001929
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25836
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: