Provider Demographics
NPI:1679585673
Name:WILLIAMSON, NATHAN A (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:A
Last Name:WILLIAMSON
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 1:1515 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-4244
Mailing Address - Country:US
Mailing Address - Phone:601-425-4893
Mailing Address - Fax:601-428-8633
Practice Address - Street 1:1515 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4244
Practice Address - Country:US
Practice Address - Phone:601-425-4893
Practice Address - Fax:601-428-8633
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09662207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09552566Medicaid
MS080003973Medicare ID - Type Unspecified
MS080003975Medicare ID - Type Unspecified
MS080003970Medicare ID - Type Unspecified
MS080003971Medicare ID - Type Unspecified
MS080003976Medicare ID - Type Unspecified
MS080003968Medicare ID - Type Unspecified
MS080003972Medicare ID - Type Unspecified
MS080003969Medicare ID - Type Unspecified
MS09552566Medicaid
MSC72193Medicare UPIN
MS080003974Medicare ID - Type Unspecified