Provider Demographics
NPI:1467446963
Name:WILLIAMS, WENDY E (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:E
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15190 COMMUNITY RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-3485
Mailing Address - Country:US
Mailing Address - Phone:228-328-1401
Mailing Address - Fax:228-328-1440
Practice Address - Street 1:15190 COMMUNITY RD
Practice Address - Street 2:SUITE 270
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3485
Practice Address - Country:US
Practice Address - Phone:228-328-1401
Practice Address - Fax:228-328-1440
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18570208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1285660688Medicaid
MS06184861Medicaid
MS370000425Medicare ID - Type Unspecified
MS06184861Medicaid