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NPI Code Detail

MEDICARE: MIDSOUTH TRANSITIONS MEDICAL GROUP

MEDICARE: MIDSOUTH TRANSITIONS MEDICAL GROUP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner
2207RG0300XGeriatric Medicine (Internal Medicine) Physician
3207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1790262681
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIDSOUTH TRANSITIONS MEDICAL GROUP
Provider Business Mailing Address
First Line : 5904 SUMMERFIELD DR
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-4306
Country : US
Telephone Number : 430-200-4350
Fax Number :
Provider Business Practice Location Address
First Line : 5904 SUMMERFIELD DR
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-4306
Country : US
Telephone Number : 430-200-4350
Fax Number : 866-337-1615
Authorized Official
Title or Position : PRESIDENT
Name : COY WILLIAMSON
Credential :
Telephone Number : 903-733-3729
Provider Enumeration Date : 07/24/2018
Last Update Date : 04/09/2026

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Directions to “MIDSOUTH TRANSITIONS MEDICAL GROUP ” Practice Location

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