Provider Demographics
NPI:1104823541
Name:WILLIAMS, JAMES REGINALD (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:REGINALD
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2298 SPRINGPORT RD
Mailing Address - Street 2:STE B
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-1475
Mailing Address - Country:US
Mailing Address - Phone:517-784-3950
Mailing Address - Fax:517-817-1681
Practice Address - Street 1:2200 SPRINGPORT RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-1432
Practice Address - Country:US
Practice Address - Phone:517-784-9356
Practice Address - Fax:517-780-9286
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062654207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4473778-10Medicaid
MIB95731Medicare UPIN
MIM12180013Medicare ID - Type UnspecifiedMEDICARE PART B