Provider Demographics
NPI:1790467520
Name:WILLINGHAM, SHARON RENEA
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:RENEA
Last Name:WILLINGHAM
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 1:2414 BULL ST RM 203
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-1906
Mailing Address - Country:US
Mailing Address - Phone:864-367-6450
Mailing Address - Fax:
Practice Address - Street 1:2414 BULL ST RM 203
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-1906
Practice Address - Country:US
Practice Address - Phone:803-898-8581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker