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Individual

MICHAEL R. WILLIAMS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
NP

Contact information

Practice address
1850 CHADWICK DR, JACKSON, MS 39204-3404
(904) 805-1300
(904) 805-1302
Mailing address
PO BOX 588, CANTON, MS 39046-0588
(904) 805-1300
(904) 805-1302

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R754167
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
08221076
MS
01
202011213A
BLUE CROSS
MS
01
582446825
CHAMPUS
MS
Enumeration date
06/16/2006
Last updated
08/03/2017
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