Provider Demographics
NPI:1750497806
Name:WILLIAMS, CHARLIE BROOKS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLIE
Middle Name:BROOKS
Last Name:WILLIAMS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 TOWER DR APT 701
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-7450
Mailing Address - Country:US
Mailing Address - Phone:228-523-5572
Mailing Address - Fax:
Practice Address - Street 1:400 VETERANS AVE
Practice Address - Street 2:DEPT OF SURGERY (112)
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2410
Practice Address - Country:US
Practice Address - Phone:228-523-5572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL6583208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC12525Medicare UPIN