Healthcare Provider Details

I. General information

NPI: 1093270316
Provider Name (Legal Business Name): BARRETT O'BRIEN WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4519 NEESES HWY
NEESES SC
29107-9415
US

IV. Provider business mailing address

4519 NEESES HWY
NEESES SC
29107-9415
US

V. Phone/Fax

Practice location:
  • Phone: 803-860-0472
  • Fax:
Mailing address:
  • Phone: 803-860-0472
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: