Healthcare Provider Details

I. General information

NPI: 1902696123
Provider Name (Legal Business Name): MR. WILLIAM TANNER SLAY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2025
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MARSHALL ST STE 301
JACKSON MS
39202-1687
US

IV. Provider business mailing address

2214 5TH STREET ROSENBAUM BLDG ROSENB
MERIDIAN MS
39301
US

V. Phone/Fax

Practice location:
  • Phone: 601-353-9900
  • Fax:
Mailing address:
  • Phone: 601-484-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00921
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: