Provider Demographics
NPI:1558817809
Name:MAYO, WILLIAM WORRALL (APRN)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WORRALL
Last Name:MAYO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 EDWARDS HALL
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29634-0742
Mailing Address - Country:US
Mailing Address - Phone:864-656-3076
Mailing Address - Fax:864-656-1123
Practice Address - Street 1:101 EDWARDS HALL
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29634-0742
Practice Address - Country:US
Practice Address - Phone:864-656-3076
Practice Address - Fax:864-656-1123
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20201363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily