Provider Demographics
NPI:1043468234
Name:WILLIAMS, MARILYN D (NP)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:D
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:129 E STARLING ST STE A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-4725
Mailing Address - Country:US
Mailing Address - Phone:662-378-8868
Mailing Address - Fax:662-378-8462
Practice Address - Street 1:129 E STARLING ST STE A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-4725
Practice Address - Country:US
Practice Address - Phone:662-378-8868
Practice Address - Fax:662-378-8462
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MSR745833363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01582712Medicaid
MS00000162Medicare PIN
MS01582712Medicaid