Provider Demographics
NPI:1881823409
Name:WILLIAMS, JACK SHELTON JR (RN)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:SHELTON
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 ACQUONI RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHEROKEE
Mailing Address - State:NC
Mailing Address - Zip Code:28719-0666
Mailing Address - Country:US
Mailing Address - Phone:828-497-1991
Mailing Address - Fax:828-497-8194
Practice Address - Street 1:806 ACQUONI RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHEROKEE
Practice Address - State:NC
Practice Address - Zip Code:28719-0666
Practice Address - Country:US
Practice Address - Phone:828-497-1991
Practice Address - Fax:828-497-8194
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC228862163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse