Healthcare Provider Details

I. General information

NPI: 1518068873
Provider Name (Legal Business Name): MARVA DENISE WILLIAMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 SUNSET DR
MANNING SC
29102-2904
US

IV. Provider business mailing address

107 SUNSET DR
MANNING SC
29102-2904
US

V. Phone/Fax

Practice location:
  • Phone: 803-435-4447
  • Fax: 803-435-9092
Mailing address:
  • Phone: 803-435-4447
  • Fax: 803-435-9092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number22121
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number22121
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1689194060
Identifier TypeOTHER
Identifier StateSC
Identifier IssuerNPI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: