Healthcare Provider Details

I. General information

NPI: 1760564660
Provider Name (Legal Business Name): WILLIAM THOMAS WILLIAMS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 04/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST STE 500
JACKSON MS
39202-2027
US

IV. Provider business mailing address

965 RIDGE LAKE BLVD STE 103
MEMPHIS TN
38120-9446
US

V. Phone/Fax

Practice location:
  • Phone: 601-352-2273
  • Fax: 601-714-3413
Mailing address:
  • Phone: 901-227-3255
  • Fax: 901-227-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number18909
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: