Healthcare Provider Details

I. General information

NPI: 1073625273
Provider Name (Legal Business Name): MR. WILLIAM C RENFROW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HEIGHTS DR
CLINTON MS
39056-6602
US

IV. Provider business mailing address

110 HEIGHTS DR
CLINTON MS
39056-6602
US

V. Phone/Fax

Practice location:
  • Phone: 601-826-4173
  • Fax:
Mailing address:
  • Phone: 601-826-4173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR869514
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: