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General NPI Number Information
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NPI Number | 1104037639
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Entity Type | Individual
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Provider Name | JEFFREY G MCWILLIAMS SR. MD
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Gender | Male
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Dates
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Enumeration Date | 05/25/2007
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Last Update Date | 07/22/2022
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Provider Practice Location Address
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Address Line | 1300 N 6TH ST UNIT A
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City | LONGVIEW
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State | TX
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Zip | 75601-5567
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Country | US
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Telephone | 903-232-8928
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Fax | 903-234-1639
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Provider Business Mailing Address
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Address Line | 112 OAK ISLE
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City | LONGVIEW
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State | TX
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Zip | 75605
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Country | US
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Telephone | 903-663-0396
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | N7143
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | N7143
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD203850
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 269656
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License Number State | OK
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