Healthcare Provider Details

I. General information

NPI: 1871683268
Provider Name (Legal Business Name): WILLIAM ERIC STANLEY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 COKESBURY RD
HODGES SC
29653-9181
US

IV. Provider business mailing address

3410 COKESBURY RD
HODGES SC
29653-9181
US

V. Phone/Fax

Practice location:
  • Phone: 864-227-2099
  • Fax: 864-227-1779
Mailing address:
  • Phone: 864-227-2099
  • Fax: 864-227-1779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1860
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: