Provider Demographics
NPI:1861296246
Name:MOORE, WILLIAM GARRISON
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GARRISON
Last Name:MOORE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 LOCKWOOD DR APT 5H
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-1131
Mailing Address - Country:US
Mailing Address - Phone:803-360-6231
Mailing Address - Fax:
Practice Address - Street 1:145 SUNSET CT STE 100
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-2464
Practice Address - Country:US
Practice Address - Phone:803-739-3550
Practice Address - Fax:803-739-3546
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program