Williamsburg Medical Associates PA

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

5526 Issued in SC

Legal business name

WILLIAMSBURG MEDICAL ASSOCIATES PA

Practice address

500 Thurgood Marshall Blvd
Suite F
Kingstree, SC 29556

Phone

(843) 355-7461

Fax

(843) 355-3616

NPI assigned

Feb 5, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Peggy V Mims, OFFICE MANAGER ASSIS

Title

Office Manager Assistant

Phone

(843) 355-7461

Specialties & licenses 2

Addresses

Other identifiers 5

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199923200000",
    "number": "1073652137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 THURGOOD MARSHALL BLVD",
            "address_2": "SUITE F",
            "city": "KINGSTREE",
            "state": "SC",
            "postal_code": "29556",
            "telephone_number": "843-355-7461",
            "fax_number": "843-355-3616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 THURGOOD MARSHALL BLVD",
            "address_2": "SUITE F",
            "city": "KINGSTREE",
            "state": "SC",
            "postal_code": "29556",
            "telephone_number": "843-355-7461",
            "fax_number": "843-355-3616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAMSBURG MEDICAL ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2008-01-10",
        "status": "A",
        "authorized_official_last_name": "MIMS",
        "authorized_official_first_name": "PEGGY",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "OFFICE MANAGER ASSISTANT",
        "authorized_official_telephone_number": "843-355-7461",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "OFFICE MANAGER ASSIS"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "SC",
            "license": "5526",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "SC",
            "license": "5526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PA7215",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RURAL HEALTH MEDICARE",
            "identifier": "428935",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "055264",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RURAL HEALTH MEDICARE",
            "identifier": "428935",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RURAL HEALTH MEDICAID",
            "identifier": "RHC103",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shadera Williams
• Williamsburg Chiropractic and Wellness Center LLC
• Williamsburg County Alcohol and Drug Abuse
• Williamsburg County Disabilities and Special Needs Board
• Williamsburg County School District
• Williamsburg Recruitment & Staffing
• Williamsburg Regional Hospital (Williamsburg Regional Health Center)
• Williamsburg Regional Hospital
• Williamsburg Regional Hospital (Williamsburg Foot Center)
• Williamsburg Regional Hospital (Williamsburg Foot Center)

• Rural Health Clinic/Center in Kingstree, SC
• Providers in Kingstree, SC by specialty
• Rural Health Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.