Healthcare Provider Details

I. General information

NPI: 1205770708
Provider Name (Legal Business Name): RESURRECTION HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1520 REMOUNT RD
NORTH CHARLESTON SC
29406-3233
US

IV. Provider business mailing address

1520 REMOUNT RD
NORTH CHARLESTON SC
29406-3233
US

V. Phone/Fax

Practice location:
  • Phone: 843-566-5693
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN DAVID WILLIAMSON
Title or Position: CEO
Credential: MD, MBA
Phone: 270-363-8059