Provider Demographics
NPI:1902262769
Name:WILLIAMS, MAGGIE
Entity Type:Individual
Prefix:MRS
First Name:MAGGIE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:PEAK
Mailing Address - State:SC
Mailing Address - Zip Code:29122-0117
Mailing Address - Country:US
Mailing Address - Phone:803-924-5625
Mailing Address - Fax:
Practice Address - Street 1:1415 PARKWAY
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4044
Practice Address - Country:US
Practice Address - Phone:864-227-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-10
Last Update Date:2016-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5449235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist