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NPI Code Detail

MEDICARE: PHYLLIS H WILLIAMSON A.C.N.P.

MEDICARE: PHYLLIS H WILLIAMSON A.C.N.P.
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
1363L00000XNurse PractitionerAPN1183SC
2363LA2100XAcute Care Nurse PractitionerAPN1183SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962404780
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHYLLIS H WILLIAMSON A.C.N.P.
Provider Business Mailing Address
First Line : PO BOX 743904
Second Line :
City : ATLANTA
State : GA
Zip : 30374-3904
Country : US
Telephone Number : 803-296-7320
Fax Number :
Provider Business Practice Location Address
First Line : 8 RICHLAND MEDICAL PARK DR STE 100
Second Line :
City : COLUMBIA
State : SC
Zip : 29203-8006
Country : US
Telephone Number : 803-434-3800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2005
Last Update Date : 11/02/2018

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