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General NPI Number Information
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NPI Number | 1902696123
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Entity Type | Individual
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Provider Name | MR. WILLIAM TANNER SLAY
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Gender | Male
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Dates
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Enumeration Date | 05/09/2025
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 501 MARSHALL ST STE 301
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City | JACKSON
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State | MS
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Zip | 39202-1687
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Country | US
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Telephone | 601-353-9900
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Fax |
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Provider Business Mailing Address
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Address Line | 2214 5TH STREET ROSENBAUM BLDG ROSENB
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City | MERIDIAN
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State | MS
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Zip | 39301
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Country | US
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Telephone | 601-484-0100
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA00921
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License Number State | MS
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