Provider Demographics
NPI:1760486724
Name:CONNORS, WILLIAM PATRICK (PA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PATRICK
Last Name:CONNORS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:843-777-7082
Mailing Address - Fax:843-777-7102
Practice Address - Street 1:101 JOHNS ST STE 100
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2777
Practice Address - Country:US
Practice Address - Phone:843-662-5233
Practice Address - Fax:843-678-9003
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006171-0363A00000X
SC2469363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2617PAMedicaid
CC7484Medicare ID - Type Unspecified