Provider Demographics
NPI:1962949933
Name:WILLIAMSBURG REGIONAL HOSPITAL
Entity type:Organization
Organization Name:WILLIAMSBURG REGIONAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRACTICE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DORRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-355-1772
Mailing Address - Street 1:500 THURGOOD MARSHALL HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-4143
Mailing Address - Country:US
Mailing Address - Phone:843-355-0174
Mailing Address - Fax:843-355-0123
Practice Address - Street 1:500 THURGOOD MARSHALL HWY
Practice Address - Street 2:SUITE B
Practice Address - City:KINGSTREE
Practice Address - State:SC
Practice Address - Zip Code:29556-4143
Practice Address - Country:US
Practice Address - Phone:843-355-5363
Practice Address - Fax:843-355-5365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-27
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty