Provider Demographics
NPI:1316187040
Name:FISHER, WILLIAM MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MATTHEW
Last Name:FISHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1005
Mailing Address - Street 2:ONE HAVENWOOD LANE
Mailing Address - City:TRAVELERS REST
Mailing Address - State:SC
Mailing Address - Zip Code:29690
Mailing Address - Country:US
Mailing Address - Phone:864-834-8013
Mailing Address - Fax:864-834-6977
Practice Address - Street 1:ONE HAVENWOOD LANE
Practice Address - Street 2:
Practice Address - City:TRAVELERS REST
Practice Address - State:SC
Practice Address - Zip Code:29690
Practice Address - Country:US
Practice Address - Phone:864-834-8013
Practice Address - Fax:864-834-6977
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL310772084P0800X
SC310772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry