Provider Demographics
NPI:1508166745
Name:WILLIAMS, HEATHER EDMONDS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:EDMONDS
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:ELIZABETH
Other - Last Name:EDMONDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 3239
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-3239
Mailing Address - Country:US
Mailing Address - Phone:843-777-7043
Mailing Address - Fax:843-777-7041
Practice Address - Street 1:101 S RAVENEL ST STE 230
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2624
Practice Address - Country:US
Practice Address - Phone:843-777-7043
Practice Address - Fax:843-777-7041
Is Sole Proprietor?:No
Enumeration Date:2010-10-21
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1587363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1082PAMedicaid
NC8101804Medicaid
SCP00911767OtherRAILROAD MEDICARE
SC1082PAMedicaid
SCAA61618568Medicare PIN