Healthcare Provider Details

I. General information

NPI: 1578201984
Provider Name (Legal Business Name): COURTNEY CHEVELLE WILLIAMS DNP, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2022
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 HERLONG AVE S
ROCK HILL SC
29732-1158
US

IV. Provider business mailing address

14221 LAUGHING GULL DR
CHARLOTTE NC
28278-7196
US

V. Phone/Fax

Practice location:
  • Phone: 803-329-6711
  • Fax:
Mailing address:
  • Phone: 254-247-8092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number7924
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number240063
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: