Provider Demographics
NPI:1073540670
Name:WILLIAMS, FRED RANDALL (ATC)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:RANDALL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 CROOKED CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-9427
Mailing Address - Country:US
Mailing Address - Phone:803-345-9981
Mailing Address - Fax:
Practice Address - Street 1:300 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-9422
Practice Address - Country:US
Practice Address - Phone:803-575-5416
Practice Address - Fax:803-575-5421
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0552255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer