1760590954 NPI number — PRISMA HEALTH-MIDLANDS

Table of content: DR. ANTHONY RASHAD WILLIAMS M.D. (NPI 1730421231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760590954 NPI number — PRISMA HEALTH-MIDLANDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRISMA HEALTH-MIDLANDS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1760590954
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 402121
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30384-2121
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-454-9604
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1205 COLONIAL LIFE BLVD W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29210-7671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-296-3100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
POLLY
Authorized Official Middle Name:
H
Authorized Official Title or Position:
VP PAYOR STRATEGIES ALIGNMENT
Authorized Official Telephone Number:
864-522-2286

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  148 , 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: 273557 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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