Healthcare Provider Details

I. General information

NPI: 1073550273
Provider Name (Legal Business Name): MARIE JAQUELINE WILLIAMS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MARSHALL ST SUITE 600
JACKSON MS
39202-1651
US

IV. Provider business mailing address

501 MARSHALL ST STE 605
JACKSON MS
39202-1650
US

V. Phone/Fax

Practice location:
  • Phone: 601-948-6540
  • Fax: 601-326-1501
Mailing address:
  • Phone: 601-948-6540
  • Fax: 601-326-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberR830287
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: