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General NPI Number Information
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NPI Number | 1942810569
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Entity Type | Individual
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Provider Name | ERICKA MARCENE WILLIAMS FNP
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Gender | Female
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Dates
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Enumeration Date | 08/07/2020
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Last Update Date | 08/07/2020
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Provider Practice Location Address
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Address Line | 1031 NORTHRIDGE RD STE A
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City | BALDWYN
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State | MS
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Zip | 38824-1173
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Country | US
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Telephone | 662-365-9305
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Fax | 662-365-9304
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Provider Business Mailing Address
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Address Line | 7 COUNTY ROAD 468
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City | RIENZI
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State | MS
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Zip | 38865-9142
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Country | US
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Telephone | 251-518-1069
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 903718
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License Number State | MS
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