Provider Demographics
NPI:1407416324
Name:WILLIAMS, GLORIA BENOIT (NP)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:BENOIT
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:889 ROYAL OAK WAY
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-8012
Mailing Address - Country:US
Mailing Address - Phone:704-574-0664
Mailing Address - Fax:
Practice Address - Street 1:889 ROYAL OAK WAY
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-8012
Practice Address - Country:US
Practice Address - Phone:704-574-0664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22905363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily