Provider Demographics
NPI:1851109763
Name:WILLIAMS, QUINCY
Entity type:Individual
Prefix:MR
First Name:QUINCY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 HOPEWELL RD
Mailing Address - Street 2:
Mailing Address - City:GIFFORD
Mailing Address - State:SC
Mailing Address - Zip Code:29923
Mailing Address - Country:US
Mailing Address - Phone:803-842-1717
Mailing Address - Fax:
Practice Address - Street 1:1130 CLECKLEY BLVD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-1302
Practice Address - Country:US
Practice Address - Phone:803-842-1717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172A00000X
SC101188823172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver