Provider Demographics
NPI:1952414690
Name:WILLIAMS, MARY JEANNE (ANP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JEANNE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:JEANNE
Other - Last Name:GREEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:2995 REIDVILLE RD STE 100
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-5600
Practice Address - Country:US
Practice Address - Phone:864-587-3000
Practice Address - Fax:864-587-3019
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17838363LA2200X
WARN00167954163W00000X
OR082012332RN163W00000X
OR082012332N3 ANP-PP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC69136067OtherMEDICARE PIN
OR083233Medicaid
SCNP3474Medicaid
SCSC69136084OtherMEDICARE PIN