Healthcare Provider Details

I. General information

NPI: 1942810569
Provider Name (Legal Business Name): ERICKA MARCENE WILLIAMS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 NORTHRIDGE RD STE A
BALDWYN MS
38824-1173
US

IV. Provider business mailing address

7 COUNTY ROAD 468
RIENZI MS
38865-9142
US

V. Phone/Fax

Practice location:
  • Phone: 662-365-9305
  • Fax: 662-365-9304
Mailing address:
  • Phone: 251-518-1069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number903718
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: