Provider Demographics
NPI:1134777543
Name:WILLIAMS, SHAVON (APRN)
Entity type:Individual
Prefix:
First Name:SHAVON
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 EAST HAMPTON STREET
Mailing Address - Street 2:ANDERSON
Mailing Address - City:SOUTH CAROLINA
Mailing Address - State:SC
Mailing Address - Zip Code:29624
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:611 EAST HAMPTON STREET
Practice Address - Street 2:ANDERSON
Practice Address - City:SOUTH CAROLINA
Practice Address - State:SC
Practice Address - Zip Code:29624
Practice Address - Country:US
Practice Address - Phone:864-226-5054
Practice Address - Fax:864-226-5643
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23144363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily