Healthcare Provider Details

I. General information

NPI: 1508166745
Provider Name (Legal Business Name): HEATHER EDMONDS WILLIAMS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER ELIZABETH EDMONDS PA-C

II. Dates (important events)

Enumeration Date: 10/21/2010
Last Update Date: 06/04/2024
Certification Date: 06/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S RAVENEL ST STE 230
FLORENCE SC
29506-2624
US

IV. Provider business mailing address

PO BOX 3239
FLORENCE SC
29502-3239
US

V. Phone/Fax

Practice location:
  • Phone: 843-777-7043
  • Fax: 843-777-7041
Mailing address:
  • Phone: 843-777-7043
  • Fax: 843-777-7041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1587
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: