Provider Demographics
NPI:1528259736
Name:VANN, WILLIAM COLLINS (CPO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:COLLINS
Last Name:VANN
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4739 HIGHWAY 17 BYP S
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-6682
Mailing Address - Country:US
Mailing Address - Phone:843-293-4904
Mailing Address - Fax:843-293-2461
Practice Address - Street 1:4739 HIGHWAY 17 BYP S
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-6682
Practice Address - Country:US
Practice Address - Phone:843-293-4904
Practice Address - Fax:843-293-2461
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management