Healthcare Provider Details

I. General information

NPI: 1366537623
Provider Name (Legal Business Name): WILLIE JAMES HILL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 EAST WOODROW WILSON AVE SUITE F
JACKSON MS
39216-4505
US

IV. Provider business mailing address

514 F EAST WOODROW WILSON AVE
JACKSON MS
39216-4505
US

V. Phone/Fax

Practice location:
  • Phone: 601-982-3132
  • Fax: 601-982-3136
Mailing address:
  • Phone: 601-982-3121
  • Fax: 601-982-3136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1837-79
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberOS-24-79
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: