Provider Demographics
NPI:1104635416
Name:WILLIAMS, JAH'RENA EBONAE (BA, ABO, LDO)
Entity type:Individual
Prefix:
First Name:JAH'RENA
Middle Name:EBONAE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:BA, ABO, LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10060 TWO NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4396
Mailing Address - Country:US
Mailing Address - Phone:803-419-6240
Mailing Address - Fax:803-419-6742
Practice Address - Street 1:10060 TWO NOTCH RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4396
Practice Address - Country:US
Practice Address - Phone:803-419-6240
Practice Address - Fax:803-419-6742
Is Sole Proprietor?:No
Enumeration Date:2025-01-01
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1460156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician