Provider Demographics
NPI:1467150425
Name:WILLIAMS, BONITA L
Entity Type:Individual
Prefix:
First Name:BONITA
Middle Name:L
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:PO BOX 14565
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29610-4565
Mailing Address - Country:US
Mailing Address - Phone:864-918-9637
Mailing Address - Fax:
Practice Address - Street 1:208 SONORA DR
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-9316
Practice Address - Country:US
Practice Address - Phone:864-918-9637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No372600000XNursing Service Related ProvidersAdult Companion