Provider Demographics
NPI:1477619765
Name:SIMS, WILLIAM QUINCEY (CRNA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:QUINCEY
Last Name:SIMS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 GINGER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHERAW
Mailing Address - State:SC
Mailing Address - Zip Code:29520-4432
Mailing Address - Country:US
Mailing Address - Phone:843-537-1120
Mailing Address - Fax:
Practice Address - Street 1:1138 CHERAW STREET
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-2466
Practice Address - Country:US
Practice Address - Phone:843-479-2881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC035623367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN0229Medicaid
SCAN0229Medicaid