Healthcare Provider Details

I. General information

NPI: 1851913842
Provider Name (Legal Business Name): PREMIER PODIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 05/12/2020
Certification Date: 05/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5434 RIVER THAMES RD
JACKSON MS
39211-4133
US

IV. Provider business mailing address

5434 RIVER THAMES RD
JACKSON MS
39211-4133
US

V. Phone/Fax

Practice location:
  • Phone: 662-473-6476
  • Fax: 662-335-5872
Mailing address:
  • Phone: 662-473-6476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. CAREY CRAIG WILLIAMS
Title or Position: PODIATRIST
Credential: DPM
Phone: 662-473-6476