1336730621 NPI number — CHRISTY L JORDAN-WILLIAMS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336730621 NPI number — CHRISTY L JORDAN-WILLIAMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JORDAN-WILLIAMS
Provider First Name:
CHRISTY
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1336730621
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 292
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENWOOD
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29648-0292
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-507-9149
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 W PUBLIC SQ STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAURENS
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29360-2972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-507-9149
Provider Business Practice Location Address Fax Number:
864-778-5592
Provider Enumeration Date:
01/29/2021

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: 101YP2500X , with the licence number:  8925 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PC2938 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: SCV568R393 . This is a "MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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