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General NPI Number Information
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NPI Number | 1275565848
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Entity Type | Individual
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Provider Name | JESSE J. WILLIAMS P.A.
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Gender | Male
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 06/21/2013
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Provider Practice Location Address
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Address Line | 701 GROVE RD
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City | GREENVILLE
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State | SC
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Zip | 29605-5611
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Country | US
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Telephone | 864-455-7000
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Fax |
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Provider Business Mailing Address
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Address Line | ONE INDEPENDENCE POINTE SUITE 212
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City | GREENVILLE
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State | SC
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Zip | 29615-4566
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Country | US
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Telephone | 864-797-6044
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Fax | 864-797-6198
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 1123
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License Number State | SC
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