Healthcare Provider Details

I. General information

NPI: 1568431963
Provider Name (Legal Business Name): A TERREL WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 12/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 OLD CANTON RD SUITE 350
JACKSON MS
39216-4200
US

IV. Provider business mailing address

3000 OLD CANTON RD STE 305
JACKSON MS
39216-4245
US

V. Phone/Fax

Practice location:
  • Phone: 601-981-1550
  • Fax: 601-981-0804
Mailing address:
  • Phone: 601-981-1550
  • Fax: 601-981-0804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number9205
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: