Provider Demographics
NPI:1790005940
Name:SMITH-WILLIAMS, STACIAN (RN)
Entity Type:Individual
Prefix:
First Name:STACIAN
Middle Name:
Last Name:SMITH-WILLIAMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 PIEDMONT GOLF COURSE RD
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-8535
Mailing Address - Country:US
Mailing Address - Phone:864-325-6671
Mailing Address - Fax:864-631-1590
Practice Address - Street 1:509 PIEDMONT GOLF COURSE RD
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-8535
Practice Address - Country:US
Practice Address - Phone:864-325-6671
Practice Address - Fax:864-631-1590
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC98823163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health