Healthcare Provider Details

I. General information

NPI: 1124192109
Provider Name (Legal Business Name): WILLIAMSBURG REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 NELSON BLVD
KINGSTREE SC
29556-4027
US

IV. Provider business mailing address

500 NELSON BLVD
KINGSTREE SC
29556-4027
US

V. Phone/Fax

Practice location:
  • Phone: 843-355-8888
  • Fax: 843-355-9994
Mailing address:
  • Phone: 843-355-0303
  • Fax: 843-355-0116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. ALLEN ABERNETHY
Title or Position: CEO
Credential:
Phone: 843-355-0151