Healthcare Provider Details

I. General information

NPI: 1194215798
Provider Name (Legal Business Name): ANNALILY B WILLIAMS PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2018
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 STONY LANDING RD
MONCKS CORNER SC
29461-3967
US

IV. Provider business mailing address

3445 INGLESIDE BLVD
LADSON SC
29456-4142
US

V. Phone/Fax

Practice location:
  • Phone: 843-761-8282
  • Fax: 843-761-7308
Mailing address:
  • Phone: 843-782-2000
  • Fax: 843-790-1778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number243812
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26380
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: