Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 3506-09 | MS |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 3506-09 | MS |
N | 204E00000X | Oral & Maxillofacial Surgeon | T-3050 | MS |
NPI | 1144452293 |
---|---|
Provider Name | Dr. James Frazier Williams |
First Address | Jackson, MS 39216-4500 |
Second Address | Jackson, MS 39216-4500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2009 |
Last Update Date | 09/08/2016 |