Provider Demographics
NPI:1669484655
Name:WILLIAMS, BRIAN K (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:K
Last Name:WILLIAMS
Suffix:
Gender:M
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:PO BOX 1249
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-1249
Mailing Address - Country:US
Mailing Address - Phone:601-735-5151
Mailing Address - Fax:601-735-5205
Practice Address - Street 1:950 MATTHEW DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-2567
Practice Address - Country:US
Practice Address - Phone:601-735-5151
Practice Address - Fax:601-735-5205
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15468207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0120926Medicaid
MS080003560Medicare ID - Type Unspecified
MS080003557Medicare ID - Type Unspecified
MS080003562Medicare ID - Type Unspecified
MS0120926Medicaid
MS080003559Medicare ID - Type Unspecified
MS080003563Medicare ID - Type Unspecified
MS080003561Medicare ID - Type Unspecified
MSG95271Medicare UPIN
MS080003564Medicare ID - Type Unspecified
MS080003565Medicare ID - Type Unspecified
MS080003567Medicare ID - Type Unspecified