Provider Demographics
NPI:1689137044
Name:WILLIAMS, BERTHA REE
Entity Type:Individual
Prefix:
First Name:BERTHA
Middle Name:REE
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 1:25 WOODS LAKE RD STE 305
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2762
Mailing Address - Country:US
Mailing Address - Phone:864-553-3340
Mailing Address - Fax:864-283-6996
Practice Address - Street 1:25 WOODS LAKE RD STE 305
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2762
Practice Address - Country:US
Practice Address - Phone:864-263-7245
Practice Address - Fax:864-283-6996
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-11
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCIHCP-1171251E00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Yes251E00000XAgenciesHome Health