Individual
DR. LORETTA JACKSON-WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-2538
(601) 815-1854
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-2538
(601) 815-1854
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
16332
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000019149
—
MS
01
—
512G700003
MS MEDICARE - GROUP
MS
01
—
930088703
RAILROAD MEDICARE
MS
01
—
P00613193
MEDICARE RR#
MS
Enumeration date
07/12/2006
Last updated
11/17/2015
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