Provider Demographics
NPI:1528609948
Name:WILLIAMS, TONTALIA
Entity type:Individual
Prefix:MISS
First Name:TONTALIA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 TROY WEST RD
Mailing Address - Street 2:
Mailing Address - City:MC CORMICK
Mailing Address - State:SC
Mailing Address - Zip Code:29835-7817
Mailing Address - Country:US
Mailing Address - Phone:864-337-2413
Mailing Address - Fax:
Practice Address - Street 1:108 OAK STREET
Practice Address - Street 2:
Practice Address - City:MCCORMICK
Practice Address - State:SC
Practice Address - Zip Code:29835
Practice Address - Country:US
Practice Address - Phone:864-993-6156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider