Provider Demographics
NPI:1518674746
Name:WILLIAMS, ELMIRA
Entity Type:Individual
Prefix:
First Name:ELMIRA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5360 I 55 N
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-4055
Mailing Address - Country:US
Mailing Address - Phone:769-572-7261
Mailing Address - Fax:769-572-7319
Practice Address - Street 1:5610 SHAW RD APT 321
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39209-3578
Practice Address - Country:US
Practice Address - Phone:601-500-1905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide