Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 3679 | SC |
NPI | 1902117096 |
---|---|
Provider Name | Dr. Justin Banks Williams |
First Address | Greenville, SC 29607-4034 |
Second Address | Greenville, SC 29607-4033 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2010 |
Last Update Date | 19/09/2014 |