Healthcare Provider Details

I. General information

NPI: 1124480033
Provider Name (Legal Business Name): WILLIAM ROBERT JUSTICE JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 22ND AVENUE MEDICAL TOWERS 3, THIRD FLOOR, SUITE B
MERIDIAN MS
39301
US

IV. Provider business mailing address

PO BOX 749215
ATLANTA GA
30374-9215
US

V. Phone/Fax

Practice location:
  • Phone: 601-703-8370
  • Fax: 601-703-8397
Mailing address:
  • Phone: 901-226-3186
  • Fax: 901-226-3160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25857
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: