Basic Information
| Provider Information | |||||||||
| NPI: | 1477721660 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | JAYMAS | ||||||||
| MiddleName: | RENEE | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 360 N IRBY ST | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295012808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436679414 | ||||||||
| FaxNumber: | 8436671362 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 E MARKET ST | ||||||||
| Address2: | |||||||||
| City: | TIMMONSVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291611812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433463730 | ||||||||
| FaxNumber: | 8433467687 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2008 | ||||||||
| LastUpdateDate: | 05/25/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F3292 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | NP1232 | 05 | SC | MEDICAID |