1376735399 NPI number — PAULETTE WILLIAMS CDE, RD, & LD

Table of content: PAULETTE WILLIAMS CDE, RD, & LD (NPI 1376735399)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376735399 NPI number — PAULETTE WILLIAMS CDE, RD, & LD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
PAULETTE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CDE, RD, & LD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376735399
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
227 S PENDLETON ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
EASLEY
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29640-3047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-855-7030
Provider Business Mailing Address Fax Number:
864-855-7019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
790 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
CLAYTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30525-4275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-234-6570
Provider Business Practice Location Address Fax Number:
706-782-1840
Provider Enumeration Date:
08/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  315876 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X , with the licence number: LD000046 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 71BBBWM . This is a "PTAN/LEGACY" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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