Provider Demographics
NPI:1629943758
Name:HUTTO, WILLIE MAE
Entity type:Individual
Prefix:
First Name:WILLIE
Middle Name:MAE
Last Name:HUTTO
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 1:3009 JONES BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BLACKVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29817-3278
Mailing Address - Country:US
Mailing Address - Phone:803-571-1228
Mailing Address - Fax:
Practice Address - Street 1:3009 JONES BRIDGE RD
Practice Address - Street 2:
Practice Address - City:BLACKVILLE
Practice Address - State:SC
Practice Address - Zip Code:29817-3278
Practice Address - Country:US
Practice Address - Phone:803-571-1228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-08
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)