Healthcare Provider Details

I. General information

NPI: 1952497422
Provider Name (Legal Business Name): CHARLES H WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 LAKELAND SQUARE EXT. SUITE 800
FLOWOOD MS
39232-7649
US

IV. Provider business mailing address

1000 LAKELAND SQUARE EXT. SUITE 800
FLOWOOD MS
39232-7649
US

V. Phone/Fax

Practice location:
  • Phone: 601-939-9811
  • Fax: 601-939-7272
Mailing address:
  • Phone: 601-939-9811
  • Fax: 601-939-7272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number08447
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: