Provider Demographics
NPI:1760194096
Name:WILLIAMS, SALENA
Entity Type:Individual
Prefix:
First Name:SALENA
Middle Name:
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 1:379 RICK HENRY LN
Mailing Address - Street 2:
Mailing Address - City:MC BEE
Mailing Address - State:SC
Mailing Address - Zip Code:29101-8531
Mailing Address - Country:US
Mailing Address - Phone:843-260-3609
Mailing Address - Fax:
Practice Address - Street 1:379 RICK HENRY LN
Practice Address - Street 2:
Practice Address - City:MC BEE
Practice Address - State:SC
Practice Address - Zip Code:29101-8531
Practice Address - Country:US
Practice Address - Phone:843-260-3609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty