Provider Demographics
NPI:1407234081
Name:WILLIAMS, MELODY (LPN)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 JOHN J RUSHTON RD
Mailing Address - Street 2:
Mailing Address - City:SALUDA
Mailing Address - State:SC
Mailing Address - Zip Code:29138-8558
Mailing Address - Country:US
Mailing Address - Phone:864-445-8333
Mailing Address - Fax:864-445-3518
Practice Address - Street 1:1261 HOLLYWOOD RD
Practice Address - Street 2:
Practice Address - City:SALUDA
Practice Address - State:SC
Practice Address - Zip Code:29138-8691
Practice Address - Country:US
Practice Address - Phone:864-445-8333
Practice Address - Fax:864-445-3518
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCP33866164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse