MEDICARE: ROBERT JUDSON WILLIAMS ANP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	R703788	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00302039	OTHER	MS	RR MEDICARE - FOUND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	753068151	OTHER	MS	MS PHYSICIANS CARE NETWOR
2	168390702	OTHER	MS	US DEPT OF LABOR
3	753068151	OTHER	MS	MS HEALTH PARTNERS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	753068151008	OTHER	MS	TRICARE

General Provider Information

NPI Number	:	1407825987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT JUDSON WILLIAMS ANP

Provider Business Mailing Address
First Line	:	1151 N STATE ST
Second Line	:	SUITE 408
City	:	JACKSON
State	:	MS
Zip	:	39202-2407
Country	:	US
Telephone Number	:	601-373-7722
Fax Number	:	601-373-7378

Provider Business Practice Location Address
First Line	:	7275 S SIWELL RD
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39272-9776
Country	:	US
Telephone Number	:	601-373-7722
Fax Number	:	601-373-7378

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	01/25/2012

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Directions to “ ROBERT JUDSON WILLIAMS ANP” Practice Location

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