Provider Demographics
NPI:1679381537
Name:WILLIAMS, ANDRE (LPN)
Entity type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3255 LANDMARK DR STE 204
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-8580
Mailing Address - Country:US
Mailing Address - Phone:843-475-8572
Mailing Address - Fax:
Practice Address - Street 1:3255 LANDMARK DR STE 204
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-8580
Practice Address - Country:US
Practice Address - Phone:843-475-8572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-24
Last Update Date:2024-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC48342164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse