Provider Demographics
NPI:1831070606
Name:WILLIAMS, REGINE K
Entity type:Individual
Prefix:
First Name:REGINE
Middle Name:K
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AUREUM
Other - Middle Name:CRANIAL
Other - Last Name:PROSTHETICS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:380 SPRINGHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-7934
Mailing Address - Country:US
Mailing Address - Phone:910-705-8393
Mailing Address - Fax:
Practice Address - Street 1:380 SPRINGHAVEN DR
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-7934
Practice Address - Country:US
Practice Address - Phone:910-705-8393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-09
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier