=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033565957
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES WILLIAMS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2016
-----------------------------------------------------
Last Update Date | 05/10/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 568 HIGHWAY 1 N
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38701-3171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-820-1992
-----------------------------------------------------
Fax | 662-334-6984
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 994 LEGION DR
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38703-2420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-820-1992
-----------------------------------------------------
Fax | 662-334-6984
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 172A00000X
-----------------------------------------------------
Taxonomy Name | Driver
-----------------------------------------------------
License Number | 1012263
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------