Provider Demographics
NPI:1073625273
Name:RENFROW, WILLIAM C
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:C
Last Name:RENFROW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-6602
Mailing Address - Country:US
Mailing Address - Phone:601-826-4173
Mailing Address - Fax:
Practice Address - Street 1:110 HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-6602
Practice Address - Country:US
Practice Address - Phone:601-826-4173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR869514367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08552207OtherMS MEDICAID
MS08552207OtherMS MEDICAID