Provider Demographics
NPI:1568431963
Name:WILLIAMS, A TERREL (MD)
Entity Type:Individual
Prefix:DR
First Name:A
Middle Name:TERREL
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3000 OLD CANTON RD
Mailing Address - Street 2:STE 305
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4245
Mailing Address - Country:US
Mailing Address - Phone:601-981-1550
Mailing Address - Fax:601-981-0804
Practice Address - Street 1:3000 OLD CANTON RD
Practice Address - Street 2:SUITE 350
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4200
Practice Address - Country:US
Practice Address - Phone:601-981-1550
Practice Address - Fax:601-981-0804
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS9205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00011851Medicaid
MS00011851Medicaid
B29986Medicare UPIN