Healthcare Provider Details

I. General information

NPI: 1881308740
Provider Name (Legal Business Name): HANNAH ELISABETH GUILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1563 SAND PLANT RD
SOUTH CHARLESTON WV
25309-6120
US

IV. Provider business mailing address

14 ARROWWOOD RD
SUMERCO WV
25567-9622
US

V. Phone/Fax

Practice location:
  • Phone: 43-756-1500
  • Fax: 304-756-1548
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2929
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: