Healthcare Provider Details

I. General information

NPI: 1356123301
Provider Name (Legal Business Name): MONICA WILLIAMS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 MATTHEW DR STE A
WAYNESBORO MS
39367-2566
US

IV. Provider business mailing address

951 MATTHEW DR STE A
WAYNESBORO MS
39367-2566
US

V. Phone/Fax

Practice location:
  • Phone: 601-735-2401
  • Fax: 601-735-5205
Mailing address:
  • Phone: 601-735-2401
  • Fax: 601-735-5205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR879368
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: