Provider Demographics
NPI:1295203602
Name:WILLIAMS, JOANETTA MARIE (COSMETOLOGIST)
Entity Type:Individual
Prefix:
First Name:JOANETTA
Middle Name:MARIE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:COSMETOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18956
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-8956
Mailing Address - Country:US
Mailing Address - Phone:662-967-1741
Mailing Address - Fax:
Practice Address - Street 1:806 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-2601
Practice Address - Country:US
Practice Address - Phone:601-606-7652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00-12147224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist