Provider Demographics
NPI:1891090437
Name:WILLIAMS-HOLLOWAY, LISA T (DNP)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:T
Last Name:WILLIAMS-HOLLOWAY
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:T
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP, FNP-BC
Mailing Address - Street 1:1040 WILDWOOD CENTRE DR STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-8402
Mailing Address - Country:US
Mailing Address - Phone:803-722-6001
Mailing Address - Fax:803-217-0026
Practice Address - Street 1:1040 WILDWOOD CENTRE DR STE A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29229-8402
Practice Address - Country:US
Practice Address - Phone:803-722-6001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-12
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4133363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2477Medicaid
SC4133OtherSC STATE LICENSE
SCNP2477Medicaid