Vital Aging of Williamsburg County, Inc.

Primary specialty

Home Delivered MealsTaxonomy code 332U00000X

Legal business name

VITAL AGING OF WILLIAMSBURG COUNTY, INC.

Practice address

501 North Longstreet Street
Kingstree, SC 29556

Phone

(843) 354-5496

Fax

(854) 354-3107

NPI assigned

Feb 21, 2007

Organization subpart

No

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

Authorized official

Name

Judy B Elder

Title

Executive Director

Phone

(843) 354-5496

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1306971502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 NORTH LONGSTREET STREET",
            "address_2": "P.O. BOX 450",
            "city": "KINGSTREE",
            "state": "SC",
            "postal_code": "29556",
            "telephone_number": "843-354-5496",
            "fax_number": "854-354-3107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 NORTH LONGSTREET STREET",
            "city": "KINGSTREE",
            "state": "SC",
            "postal_code": "29556",
            "telephone_number": "843-354-5496",
            "fax_number": "854-354-3107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITAL AGING OF WILLIAMSBURG COUNTY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ELDER",
        "authorized_official_first_name": "JUDY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "843-354-5496"
    },
    "taxonomies": [
        {
            "code": "332U00000X",
            "taxonomy_group": "",
            "desc": "Home Delivered Meals",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IVR PIN",
            "identifier": "4010",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samuel James Tomlinson III, M.D.
• Frank A Trefny, MD
• Uplift Dynamics LLC
• Nagasumanth Vemula, MD
• Samantha Jenkins Vereen, MASTERS
• Frances Wadford, RN
• Donya Demesha Wallace, LPC
• Lucius Franklin Wates, DMD
• Kelsey Watson, OTR/L
• Jamie Roberts Webb, LPN

• Home Delivered Meals in Kingstree, SC
• Providers in Kingstree, SC by specialty
• Home Delivered Meals in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.