Healthcare Provider Details

I. General information

NPI: 1780777847
Provider Name (Legal Business Name): AUBREY DUANE WILLIAMSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 CHADWICK DR
JACKSON MS
39204-3404
US

IV. Provider business mailing address

PO BOX 7539
JACKSON MS
39284-7539
US

V. Phone/Fax

Practice location:
  • Phone: 601-376-1848
  • Fax: 601-376-1894
Mailing address:
  • Phone: 601-376-1848
  • Fax: 601-376-1894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number10800
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number10800
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: