Healthcare Provider Details

I. General information

NPI: 1003831645
Provider Name (Legal Business Name): TWELVE MILE CREEK FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4711 SUNSET BLVD
LEXINGTON SC
29072-9151
US

IV. Provider business mailing address

4711 SUNSET BLVD
LEXINGTON SC
29072-9151
US

V. Phone/Fax

Practice location:
  • Phone: 803-356-3609
  • Fax: 803-356-3941
Mailing address:
  • Phone: 803-356-3609
  • Fax: 803-356-3941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JAMES O WILLIAMS JR.
Title or Position: PRESIDENT
Credential: M.D
Phone: 803-356-3609