MEDICARE: JACQUELINE WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	621610	SC

General Provider Information

NPI Number	:	1154122646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE WILLIAMS

Provider Business Mailing Address
First Line	:	221 SAINT JAMES AVE STE 6
Second Line	:
City	:	GOOSE CREEK
State	:	SC
Zip	:	29445-3270
Country	:	US
Telephone Number	:	843-324-4932
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 SAINT JAMES AVE STE 6
Second Line	:
City	:	GOOSE CREEK
State	:	SC
Zip	:	29445-3270
Country	:	US
Telephone Number	:	843-324-4932
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2025
Last Update Date	:	03/21/2025

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Directions to “ JACQUELINE WILLIAMS ” Practice Location

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