Healthcare Provider Details

I. General information

NPI: 1669484655
Provider Name (Legal Business Name): BRIAN K WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 MATTHEW DR
WAYNESBORO MS
39367-2567
US

IV. Provider business mailing address

PO BOX 1249
WAYNESBORO MS
39367-1249
US

V. Phone/Fax

Practice location:
  • Phone: 601-735-5151
  • Fax: 601-735-5205
Mailing address:
  • Phone: 601-735-5151
  • Fax: 601-735-5205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15468
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: