Provider Demographics
NPI:1871683268
Name:STANLEY, WILLIAM ERIC (PA-C)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ERIC
Last Name:STANLEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 COKESBURY RD
Mailing Address - Street 2:
Mailing Address - City:HODGES
Mailing Address - State:SC
Mailing Address - Zip Code:29653-9181
Mailing Address - Country:US
Mailing Address - Phone:864-227-2099
Mailing Address - Fax:864-227-1779
Practice Address - Street 1:3410 COKESBURY RD
Practice Address - Street 2:
Practice Address - City:HODGES
Practice Address - State:SC
Practice Address - Zip Code:29653-9181
Practice Address - Country:US
Practice Address - Phone:864-227-2099
Practice Address - Fax:864-227-1779
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1860363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1824PAMedicaid
SCSC2452Medicare PIN