Healthcare Provider Details

I. General information

NPI: 1710652615
Provider Name (Legal Business Name): KEVIN PAUL WILLIAMSON B.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST STE 330
JACKSON MS
39202-2027
US

IV. Provider business mailing address

1200 N STATE ST STE 330
JACKSON MS
39202-2027
US

V. Phone/Fax

Practice location:
  • Phone: 601-353-2020
  • Fax: 601-352-5988
Mailing address:
  • Phone: 601-353-2020
  • Fax: 601-352-5988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1900X
TaxonomyOrthoptist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: