Provider Demographics
NPI:1417627324
Name:WILLIAMS, GAZELLA M
Entity Type:Individual
Prefix:
First Name:GAZELLA
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 CHAMPION ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-2206
Mailing Address - Country:US
Mailing Address - Phone:803-563-7844
Mailing Address - Fax:
Practice Address - Street 1:215 CHAMPION ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-2206
Practice Address - Country:US
Practice Address - Phone:803-563-7844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No174H00000XOther Service ProvidersHealth Educator