Provider Demographics
NPI:1356138408
Name:WILLIAMS, TARA R
Entity type:Individual
Prefix:MISS
First Name:TARA
Middle Name:R
Last Name:WILLIAMS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N MACARTHUR AVE STE B
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-3434
Mailing Address - Country:US
Mailing Address - Phone:843-506-6574
Mailing Address - Fax:
Practice Address - Street 1:110 N MACARTHUR AVE STE B
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-3434
Practice Address - Country:US
Practice Address - Phone:843-506-6574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332U00000X
SCIHP-2232332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals